Director of Customer Service (Medicare Advantage)

Mass General Brigham Health Plan • Somerville, MA, United States • $200k - $250k / year • 1m ago

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated. We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.

The Director of Medicare Advantage (MA) Customer Service is responsible for leading, developing, managing, and continuously improving the Medicare Advantage Customer Service Center (CSC). In addition to leading the CSC, the Director, in conjunction with the Chief Operating Officer and Medicare Advantage Line of Business Leadership, formulates the vision of service excellence. The Director is responsible for executing the operational plan that achieves that vision within the CSC and will partner with the VP of Operations to drive that vision across the organization.

The Director is responsible for building, leading, and managing highly motivated, effective teams to deliver excellent service to Mass General Brigham Health Plan’s MA Members as measured by the Medicare STARS rating system. The CSC staff is a highly diverse and multi-generational staff that reflects our organization’s commitment to the people that we serve. The Director will be able to build upon and embrace that diversity to create a culture of inclusion resulting in service excellence to both external as well as internal customers.

Principal Duties And Responsibilities

Reports directly to COO and on a dotted lines basis to the Medicare Advantage Line of Business Leadership.
Report to COO and Medicare Line of Business Leadership monthly performance on all customer service metrics that are used by the Medicare STARS rating system.
Provide leadership, subject matter expertise, development, and mentoring of the management and staff of the MA Customer Care Center by creating a culture of high performance that is driven by strategic objectives, service excellence, and the goals and core values of MGB Health Plan.
In collaboration with the Manager of Workforce Planning, develops staffing and availability plans to respond to seasonal and daily changes in customer inquiry demands.
Collaborates with the Director of Customer Service (Commercial, Medicaid LOBs) on seamless overflow call management.
Partners with Medicare Advantage Sales team to grow and retain our business.
Develop short and long-term Call Center metrics and goals that incorporate enhanced first point-of-contact resolutions and seamless service processes. Ensure that all contractual service level expectations outlined in the CMS Medicare Advantage contract are met and that the MA CS operates in compliance with all regulatory requirements and standards.
Continuously assess whether current metrics are accurately reflecting customer preferences and needs. Track and report on key Member trends. Ensure effective and accurate measurement and reporting for the overall MA Customer Service.
Prepares and presents Medicare Advantage line of business dashboards that closely track the performance of the MA Customer Service team’s impact on the overall performance of the MA Line of Business. This information will be shared monthly across the organization.
Monitors industry and compliance trends for Medicare Advantage as the internal expert on all relevant member experience expectations.
Monitors HPMS bulletins for any relevant updates that would change customer service processes or practices.
Through close collaboration with the Medicare Advantage Compliance Officer, ensures MA Customer Service compliance documentation is maintained continuously.
Work collaboratively with other departments to represent member feedback obtained through Customer Service analysis, member satisfaction surveys, and complaints/appeals data. Strengthen MGB Health Plan’s brand and increase member satisfaction through the development of service improvement initiatives.
Work with all business areas within MGB Health Plan to ensure an accurate and consistent understanding of MA member and provider policies and procedures. Develop criteria designed to empower frontline staff to increase the percentage of “first call resolution” performance.
Work closely with Operations and Corporate Trainers to ensure the delivery of topic-specific, complete, and accurate training modules to support staff in navigating complex product designs and administrative procedures. Establish and implement feedback mechanisms for “supplied” information from other internal departments.
Ensure departmental compliance with HIPAA privacy regulations. Provide leadership to ensure member information is kept confidential through verification, access, and restriction of information when appropriate.
Lead and participate in key Operations and MGB Health Plan initiatives, such as new product development initiatives.
Create and manage departmental budget and meet financial targets.
Hold self and others accountable to meet commitments.
Ensure diversity, equity, and inclusion are integrated as a guiding principle.
Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.
Other duties as assigned with or without accommodation.

Qualifications And Experience

Bachelor’s degree required or the equivalent combination of training and experience, plus 8-10 years of related experience.
Master’s Degree preferred.
8-10 years of related MA job experience in a high-volume call center including managing staff and supervising managers/supervisors.
Within the past 3 years, must have held a supervisory role in a MA Call Center.
Must have a comprehensive understanding of metrics, leading practices, and relevant technologies for call-centering management.
Proven senior-level leadership skills in a managed care environment with experience working with Medicaid and other governmental and commercial products strongly preferred.
Ability to design, deliver, and evaluate member retention strategies and programs.
Knowledge of business and managed care environment issues that relate to consumer choice.
Demonstrated ability to design and build effective and diverse work teams.
Knowledge of Federal and State mandated benefits and other requirements is strongly preferred.
Project management skills preferred.