Manager, Member Experience

Overview of the Role:

Alignment Health is seeking an inspiring, organized, and service-oriented manager of member experience to join the member experience team. As a manager, you will oversee call center operations, implement call center strategy, improve systems and processes, and manage the member experience team. If you are looking for an opportunity to make a positive impact in the lives of seniors, have experience leading and motivating teams, inspiring teams to provide and drive an above-and-beyond member experience, anticipating and addressing member needs, and are committed to meeting and exceeding member satisfaction and service level results - we are looking for YOU!

Responsibilities:

• Define and monitor performance and productivity standards specific to those systems that must be in place to serve the health plan's enrolled population.

• Maintain high knowledge of procedures, protocols, benefits, services, systems, and any other necessary information to resolve member issues and inquiries.

• Ensure that member experience team possess the skills and training necessary to communicate effectively with the plan's membership.

• Oversee the hiring and onboarding of member experience new hires.

• Ensure member experience team answer the incoming phone queue calls according to Centers for Medicare and Medicaid Services (CMS) defined standards and according to department protocols.

• Prepare key performance indicator (KPI) reports for distribution to key stakeholders.

• Prepare performance reports by collecting, analyzing, and summarizing data and trends on production and quality.

• Identify call drivers and root causes, coordinating with leadership for mitigation.

• Participate and support discussions and other related activities for CRM development and implementation.

• Assist with the review and development of new department policies and procedures as needed.

• Develop and encourage a spirit of cooperation, teamwork, and accountability among all department employees.

• Provide direct reports with clear, concise, and appropriate communications and directions.

• Ensure direct reports are compliant with all department / company policies and procedures.

• Guide, mentor, and coach direct reports for professional development and to deepen their technical skill sets (i.e., CRM, TalkDesk, BICC, etc.,).

• Review and respond to appeal and grievance case inquiries related to customer service complaints.

• Support department compliance related activities to ensure proper monitoring and controls are in place as required for regulatory compliance audits.

Supervisory Responsibilities:

• Oversee the member experience department.

• Carry out managerial responsibilities in accordance with Alignment Health policies and applicable laws.

• Plan, assign, and direct work.

• Assist in the rewarding and disciplining of assigned employees.

• Address complaints and resolve problems as they pertain to the department.

Required Skills and Experience:

• Minimum five (5) years' call center experience required.

• Minimum three (3) years in management capacity in a compliance-driven industry required

• Management experience in health plan / Medicare industry (highly preferred)

• Knowledge of Medicare Managed Care Plans required.

• High school diploma or general education degree (GED); and three to five years related experience and / or training; or equivalent combination of education and experience required.

• Bachelor's degree in healthcare, business, or related field (preferred)

• Bilingual English and Spanish highly preferred.

• Demonstrated knowledge of CMS Call Center Metrics, CAHPS, etc.

• Possess Excellent written and verbal communication skills.

• Proven record to monitor and motivate employees; including oversight of outsource vendor and / or remote workforce a plus.

• Demonstrated success with implementation and/or management of applications, such as: workforce management, CRM, campaign manager, EMR PM, etc.

• Self-starter with strong analytical, critical thinking, problem-solving, leadership, and relationship-building skills.

• Strong interpersonal skills and a collaborative management style.

• Language Skills: Able to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Able to write routine reports and correspondence. Able to speak effectively before groups of customers or employees of the organization.

• Mathematical Skills: Able to add and subtract two-digit numbers and to multiply and divide with 10's and 100's. Able to perform these operations using units of American money and weight measurement, volume, and distance.

• Reasoning Skills: Able to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Able to deal with problems involving a few concrete variables in standardized situations.

• Advanced computer proficiency and experience with Microsoft Suite (Word, PowerPoint, Excel, Outlook) required.

• Excellent telephone techniques.

• Excellent data entry.

• Strong organizational skills.

• Able to type minimum 40 words per minute (WPM) 10-key by touch.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• The noise level in the work environment is usually moderate.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.

• The employee is frequently required to walk, stand; reach with hands and arms.

• The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl.

• The employee must occasionally lift and / or move up to 20 pounds.

• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

PAY RANGE: $72,900 - $87,000 ANNUALLY