Vice President Individual Operations and Quality

General Search & Recruitement Published:
Phoenix, AZ
Job ID


Vice President Individual Operations and Quality
Phoenix, AZ
Executive Overview:
• You will develop and manage strategy and operations to ensure quality, timely and accurate customer service, claims processing, enrollment, and overall member satisfaction for Client Company’s Individual segment programs.
• You will be accountable for identifying and prioritizing automated processes of department workflows and the use of internal resources for cost effective solutions whenever possible.
• This includes leading cross-functional team in the strategy and execution of a roadmap to identify and implement programs to improve customer experience results in QHP Enrollee Survey and Quality Rating System to achieve organizational goals.

  • You will oversee the development, planning, strategic direction, and full execution of an outstanding customer experience by the Individual Operations teams, with direct accountability for all activities associated with member claims, customer service, enrollment, billing, and engagement.

• Accountable for identifying and prioritizing automated processes of department workflows and the use of internal resources for cost effective solutions whenever possible.
• This will also include leading the brokers service representative team providing outstanding service to contracted Individual segment brokers
• Responsible for resolving all escalated problems, complaints, and settlements related to production.
• Provide operations oversight and monitoring to maintain performance levels to meet Client Company’s and CMS standards for Individual Segment.

  • Oversee day-to-day departmental administration by coaching and motivating staff and departmental personnel to make maximum use of experience and skills.

• You will actively participate as a key member of the segment leadership team, providing insights to help inform products, services and growth strategies for the segment
• Develop and align strategic plans to the corporate strategic pillars and segment plan for growth, operating income and customer experience.
• Monitor quality performance measures, develop and maintain effective workflows, and seek to maximize efficiencies.
• Manage use of corporate funds including budgeting, financial management, and reporting. Identify opportunities to achieve administrative efficiencies while maintaining service.
• Maintain effective working relationships to ensure teamwork in achieving corporate goals. Coordinate activities between multiple divisions to achieve desired results.
• Participate in strategic planning activities and contribute to departmental and cross-functional teams to achieve Client Company’s and Segment goals and ensure future success.
• Support Client Company’s Core Value of maintaining a heritage of service through community involvement.
Required Job Skills
• Advanced knowledge of quality and cost-effective customer service solutions, including proficiency in business process design and implementing operational and technical solutions.
• Resource management skills with the ability to develop an enthusiastic and positive work climate.
• Intermediate knowledge of healthcare industry, including ability to quickly learn and understand CMS and state regulatory and contractual documents.
• Exceptional written, verbal and presentation skills with the ability to collaborate with team members and business stakeholders at all levels of the organization.
• Ability to communicate with and influence constituents and stakeholders
• Intermediate PC proficiency, including Microsoft office applications.
• Intermediate knowledge of electronic data processing systems, technology and applications
• Ability to analyze and interpret data, making recommendations on appropriate customer experience strategies to improve the customer experience and advance key segment initiatives throughout organization.
Required Work Experience
• 7 years of experience in healthcare field, including knowledge of products and operational functions
• 7 years of management experience
• 5 years of experience in an operational environment
• 3 years of experience in developing short- and long-range strategic plans, forecasting, and budgeting
• Serves as a subject matter expert for the Affordable Care Act QHP Enrollee Survey and Quality Rating System (QRS) and leads cross-functional teams to implement proactive strategies that improve the overall results.
• Collaborates with other leaders to research and analyze opportunities to develop roadmap for ACA Quality Rating System (QRS) and QHP Enrollee Survey improvements across provider and member facing activities
• Develops and maintains relationships with provider and Value-Based partners to maximize effectiveness of short- and long-term strategies on the advancement provider and member engagement initiatives.
• Using emerging tools and techniques to improve customer experience, drive the implementation and execution of ongoing improvement plans and measure success using results of key metrics.
• Identify primary and secondary research needed to understand consumer needs, behaviors, barriers, and perceptions related to the segment experience.
• Coordinate and assist in development of enhancements to existing systems or creations of new systems to improve efficiencies to enrollment, customer service and claims processing.
• Develop a strong change management process for new systems (e.g. enrollment; claims platform). This includes dedicated involvement in future state mapping, ongoing implementation support, testing, and workforce readiness. Signs off on implementation only at the time when customer impact will be net positive.
• Monitor quality performance measures, develop, and maintain effective workflows, and maximize system efficiencies.

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