Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Assistant Vice President, Vendor Oversight - Call Centers

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Director and Equivalent
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1907P Requisition #
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Lead Emblem Health Operational Excellence / Customer Experience End-to-End projects to reduce administrative and medical costs, improve core process efficiency, effectiveness and responsiveness, measure and improve business critical operational KPIs/metrics and increase customer loyalty. Responsible for the day to day operations and performance of the HMO outsourced call centers to include Provider and Member calls as well as the overall quality.  This includes 5 Vendor sites and 5 different lines of business (Medicare, Medicaid, Commercial, and Provider as well as CCI Provider).  This role will have 2 Director level direct reports and will have direct responsibility for 5 Emblem employees and indirect oversight of 815 Vendor staff. Partners with the Senior CTS leadership in addressing performance related items to ensure our members and providers are given the best service possible.  Ensures Workforce models are accurate and assumptions are agreed upon to ensure the Service levels are achieved for Quality and Service. Responsible for day to day oversight and planning for the upcoming SalesForce release, portal rollouts and  FACETS migration, ensuring pilot plans, training plans and Go live plans are in place and executable with minimum disruption to overall performance. Responsible for managing our outsourced call center vendor (CTS).  Ensures performance of the vendor call centers as well as the delegated entitities ( ESI, HCP, etc..).  Identify and address opportunities as a result of operational capability analyses of core business processes, human resources and technology. Develop recommendations that drive operational excellence and customer loyalty objectives. Apply Change Leadership at all times to influence effective business decisions and outcomes.

Responsibilities:
  • Lead large-scale, end-to-end, cross-functional projects with a specific emphasis on driving results for Operational Excellence and Consumer Experience initiatives. 
  • Technically direct large, cross-functional project teams and provides individual contribution using Business Process Management, Lean and Lean Six Sigma tools and techniques to improve quality and reduce medical and administrative costs. 
  • Develop metrics, processes and procedures that drive Operational Excellence and Consumer Value. 
  • Apply Voice of the Customer and business data to scope the level of improvement required to impact customer loyalty and bottom-line results. 
  • Partner with senior and line management to facilitate implementation of recommendations. 
  • Provide direction to the CTS leadership to ensure proper alignment of resources and to ensure that corporate goals are obtained.
  • Provide direction to Outsourced vendor (CTS) to ensure they are properly aligned with Emblems vision and goals. 
  • Create and implement automated solutions to increase productivity, accuracy and to make improvements in workflow.
  • Oversight and daily coordination of the day to day performance for all of the outsourced Call Center work – to include PPO Provider, CCI Provider, HMO Member, HMO Medicare and HMO Medicaid and Pharmacy.
  • Oversight and performance management of our delegated partners such as HCP, CMO, Monte, Evicore etc…
  • Evaluate core business processes to leverage opportunities for operational improvements with an emphasis on trends, root cause analysis and customer centric metrics.
  • Ensure reports are accurate and precise when distributing to Emblem Leadership and Operational teams.
  • Participate in evaluation of IVR technology and be heavily involved in the rollout of the new technology 
  • Facilitate the alignment of systems and processes with corporate business goals. Partner with Account Directors, Business Owners and IT Information Architecture and Application Development functions to facilitate design and implementation of technological solutions for end-to-end core processes as needed.
  • Day to day leadership of the outsourced operation consisting of 5 sites 25 plus performance and quality SLA’s.  
  • Provide analytical expertise and recommendations to senior and middle management for identifying, planning, and implementing solutions to resolve ad-hoc business issues. 
  • Facilitate implementation of recommendations.
  • Responsible for: development and management of direct reports to achieve pre-established Customer and Corporate goals; accurate call center forecasting; effective and efficient resource allocation based on business needs; resource management and real time adjustment of resources.
  • Build relationships with internal groups such as HR, IT, QA and training.
  • Mentor and train cross-functional teams on Lean, Six Sigma, Process Management and Change Leadership techniques as needed to facilitate project movement.
  • Provide clear communication and collaboration between key areas to include Claims, IT, EPMO, Provider Network, Management, QA and Training in an effort to develop and implement customer focused business solutions.
  • Regular review of departmental policies and procedures to ensure alignment of work and expected results.
  • Provide clear communication of business priorities to leadership and staff with regular progress reports delivered to those involved.
Qualifications:
  • 4 year degree in a business or related discipline
  • Lean Six Sigma Black Belt or Lean Master Certification preferred
  • 10 – 12 years’ related business experience required
  • 5 years’ experience in positions designed to drive business performance improvement on a full time basis required
  • Minimum 1 year of relevant experience post certification preferred, or 
  • 7+ years in process improvement/re-engineering (i.e., Supply Chain Management, Business Process Management, Industrial Engineering, etc.) required
  • Additional years of experience may be used in lieu of educational requirement required
  • Working knowledge of Vendor Operations and experience leading large scale operations

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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