SVP, Customer Experience and Service Operations at CareSource

About this role

Job Summary: The Vice President, Customer Care is responsible for determining departmental strategies to effectively service customers and providers through the call center, the grievance and appeals process, and digital strategy to ensure operational effectiveness and regulatory compliance. Essential Functions:
Lead and manage the Customer Care, Grievance and Appeals (G & A), and Digital Strategy functions
Foster strong working relationships with Market team and all areas in which collaboration will be essential to ensure operational effectiveness, drive process improvements, and adherence
Develop strategy to align technology with business needs to deliver best-in-class member and provider digital experiences across all markets and products
Advocate for digital transformation within the business, strongly influencing the mindset, behavior and culture of the organization at executive level to ensure that the opportunities are understood and seen as a strategic imperative
Perform cost/benefit analyses for new technologies
Seek out new approaches to maximize departmental efficiencies
Ensure G & A processes drive towards achieving 5 STAR measures
Periodically survey providers and customers to evaluate performance and establish base lines
Periodically assess departmental performance through various corporate controls
Ensure that corporate service level agreements (SLA) are met or exceeded
Develop and support staff standards to ensure quality encounters with customers and providers
Monitor all regulatory requirements and oversight of all submissions in existing and future lines of business
Evaluate and trend grievance information and training evaluations to strengthen all programs
Analyze data and identify trends monthly to ensure company expectations are met
Identify information system inefficiencies and formulate recommendations
Oversee preparation of internal budgets variances for the operational departments
Develop and maintain an in-depth knowledge of the company’s business and regulatory environments
Consult with applicable regulatory entities and legal counsel as necessary to assure vendor contracts meet all regulatory standards
Perform any other job duties as requested
Education and Experience:
Bachelor of Science in business, healthcare, management, or related field or equivalent years of relevant experience is required
Master of Business Administration (MBA), Public Administration (MPA), healthcare or related field is preferred
Minimum of ten (10) years experience in a call center environment with at least five (5) years in leadership is required
MCO experience is preferred
Competencies, Knowledge and Skills:
Proficient in Microsoft Office tools
Strong analytical skills
Strategic vision and ability to conceptualize key call center trends and identify changing market demands
Excellent oral, written and interpersonal communication skills
Strong collaborator with the ability to effectively influence others
Strong Customer Service orientation
Strong leadership and strategic management skills
Ability to adapt quickly to changing business needs
Effective relationship management skills and ability to maintain strong working relationships
Critical listening and thinking skills
Negotiation skills/experience
Decision making/problem solving skills
Strong conflict resolution skills
Planning, problem identification and resolution skills
Licensure and Certification: None Working Conditions: General office environment; may be required to sit or stand for extended periods of time Compensation range $150,000-$300,000 . CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies
Fostering a Collaborative Workplace Culture
Cultivate Partnerships
Develop Self and Others
Drive Execution
Energize and Inspire the Organization
Influence Others
Pursue Personal Excellence
Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. Brand= CareSource Originally posted on Himalayas