Senior Director, Healthcare Member Contact Center

Role Overview

• Lead operational redesign and define business strategies that improve service performance, scalability, and operational efficiency across Customer Care.
• Establish and oversee integrated staffing models, cross-training strategies, and operational workflows across Customer Care, including PA Intake, specialized teams, and customer communications.
• Partner with IT leadership to ensure Customer Care systems and applications effectively support operations, analytics, and reporting, with ongoing evaluation to optimize performance and scalability.
• Serve as the accountable business owner for company customer and member experience initiatives, providing end-to-end leadership from strategy development and innovation through execution, adoption, and sustained results.
• Define performance standards, service metrics, and operating benchmarks to drive accountability and consistently exceed service-level expectations.
• Establish strong cross-functional working relationships between Customer Success, Clinical Services, Technical Operations, and Government Programs, Sales and Implementation departments to ensure seamless service delivery and client onboarding.
• Provide strategic oversight of Customer Care workforce planning, forecasting, and capacity modeling by analyzing demand trends, developing forecasts, researching business requirements, workflow design, and business growth requirements.
• Lead forward-looking strategy and the adoption of innovative methodologies to continuously enhance call center capabilities, operational performance, and technology advancement.
• Drive a culture of continuous operational improvements focused on enhancing customer experience, operational effectiveness, and quality outcomes.
• Set strategic direction for associate training, leadership development, and call center certification to ensure workforce readiness and performance excellence.
• Evaluate emerging technologies, systems, and sourcing strategies to strengthen Customer Care capabilities and improve serve delivery.
• Oversee the development, implementation, and governance of Customer care policies, procedures, and quality frameworks, including performance monitoring and corrective action.
• Ensure robust tracking, trending, and reporting of operational metrics, performance guarantees, and service outcomes.
• Provide oversight of accreditation, including application preparation, compliance maintenance of necessary documentation to demonstrate compliance with accreditation standards and coordination of on-site reviews.

Requirements

• Bachelor’s degree in Business or related field, or equivalent work experience required.
• 10+ years of progressive leadership experience overseeing large-scale, multi-channel call center or customer care operations, including accountability for performance, staffing, and service outcomes required.
• 10+ years of progressive management experience within a managed care, PBM, or comparable highly regulated health care environment, with demonstrated responsibility for complex operations and cross-functional coordination required.
• Proven record of operational leadership resulting in measurable improvements in efficiency, productivity, capacity utilization, and service performance through process redesign, workforce optimization, and performance management required.
• Demonstrated experience implementing operational and technology improvements within call center environments, including adoption of new methodologies that enhanced efficiency, customer experience metrics, and overall performance required.

Benefits

• Health insurance
• Retirement plans
• Paid time off