Director, Member & Provider Services

Bright Health Minneapolis , MN 55415

Posted 2 months ago

MISSION, VISION AND VALUES

"Making Healthcare Right. Together." is the cornerstone of all we do. Our vision is to deliver the best healthcare experience by putting brilliant minds, empathetic hearts and personalized technology to work to create meaningful relationships between our members and Care Partners. To successfully achieve our mission and vision as we operate in a dynamic health care environment, we expect Bright People to embody and uphold our core values in work and interactions, both internal and external: Be Purposeful, Be Authentic, Be Brave, Be Positive and Be Respectful

SCOPE OF ROLE

The Director of Member and Provider Services is responsible for ensuring operational effectiveness of our core Health Plan Administration call center vendors, across both Medicare Advantage and Individual & Family Plan products. As part of Constituent Services, and the broader Health Plan Administration team, this role will play a critical role in bringing Bright's Member and Provider Service strategy to life. The Director of Member and Provider Services will work cross-functionally with other Health Plan Administration teams to ensure a consistent and exceptional customer service experience for our Member and Providers.

ROLE RESPONSIBILITIES

The Director of Member and Provider Services job description is intended to point out major responsibilities within the role, but it is not limited to these items.

  • Provide operational direction for the Member and Provider Services department at Bright Health, across all lines of business (Individual and Family Plans, Medicare Advantage, and any future business lines)

  • Lead day-to-day vendor management of core health plan administration call centers for both Member and Provider Services.

  • Work cross-functionally with Product and Marketing teams to help with design, implementation and ongoing execution of our member and provider services strategy (including but not limited to call scripting, agent training, and agent recognition programs).

  • Day-to-day responsibilities of the team including, but not limited to, call volume forecasting, call tracking and listening, vendor QA process oversight and review, and call center training oversight.

  • Develop and maintain key reporting documents and dashboards and monitor and manage key call center SLAs and other quality and performance metrics as defined in vendor contracts. Includes updating and sharing operational updates with the broader organization.

  • Provide member and provider call reason and issue trend analysis and reporting to ensure continuous improvement within our member call center experience.

  • Assist with design and creation of call center job aids, workflows and processes as needed.

  • Support vendors through new process implementation and testing.

  • Understand and ensure vendors fulfill all call center regulatory requirements.

  • Work cross-functionally with Health Optimization, Pharmacy, Appeals and Grievances and other internal Bright teams and vendor partners to ensure smooth transitions and consistent experience between core Member and Provider services and other vendor call centers.

  • Build and support the Member and Provider Services team.

  • Other duties and responsibilities as assigned.

SUPERVISORY RESPONSIBILITIES

This position will have supervisory responsibilities for the Member and Provider Services team.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

  • A Bachelor's Degree in Health Care Administration, Business or a related field is required.

  • Five (5) to seven (7) years of experience working either in a call center or in a call center vendor management role is required.

  • Three (3) years Individual Health Insurance experience, Medicare Advantage or ACA exchanges strongly preferred.

PROFESSIONAL COMPETENCIES

  • Detail oriented and a great problem solver.

  • Able to thrive in fast-paced environments

  • Able to create structure and bringing operational rigor to teams

  • Self-directed with strong prioritization skills.

BEHAVIORAL AND LEADERSHIP NORMS

  • Bright Values: Lives the Bright Values. Leads by example. Is viewed as an emerging leader in the company. Acts with quiet, calm determination. Effectively influences inside of the organization.

  • Decision making: Drives strong decision making at a functional level. Is capable of taking a large sum of information, and drilling into what is important. Understands organizational impact of decisions and communicates effectively throughout the decision-making process. Pushes issues to resolution.

  • Delivers Results: Is results oriented. Is capable of deciphering priorities for self and for others, and focuses the group on what must be done today, and who must do what. Is capable of clearly translating strategic objectives into implementable processes that drive outcomes. Focuses on results, not effort, and is able to efficiently direct time and energy to achieving intended outcome. Can successfully develop a budget and achieve it without sacrificing quality of output. Achieves strong results within their functional area. Has an excellent track record of achieving expected results. Understands how to operate in collaborative framework.

  • Direct and Indirect Management: Demonstrates leadership skills. Has mastered autonomous work, and is able to successfully influence direct and indirect teams to achieve goals. Organizes people and resources toward the effective and pursuit of objectives: this includes hiring, firing, efficient supervising and performance appraisals. Delivers thoughtful and constructive feedback to teams, and actively works to develop those around them. Sets an example for our employees. Manages up appropriately and knows how and when to escalate an issue or situation to more senior manager.

  • Planning and Execution: Identifies need for planning and has skills to develop, implement, monitor and achieve plans. Knows how and when to adjust plan. Leads others in this effort. Hold self and team accountable for effective planning and execution. Overcomes hurdles.

  • Presence: Internally, leads large and small groups of people in meetings. Capable of developing thoughtful agenda, setting objectives, driving clarity of purpose and delivering the intended results. Instills confidence.

LICENSURES AND CERTIFICATIONS

  • No licensures and/or certifications are required for this role.

WORK ENVIRONMENT

The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer. Some travel will be required.


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Director, Member & Provider Services

Bright Health