Company Statement
EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.
AVP, Member Experience
Summary of Position
• Lead the enterprise definition, communication, implementation and maintenance of stakeholder experiences and journeys
(focused on Member and Provider). Partner with various functional and P&L leadership to define/refine and measure
outcomes of experience and journeys.
• Accountable for identifying and executing, in partnership with our Technology team, new technical capabilities, strategies
and potential uses of artificial intelligence capabilities that improve our member experience and quality outcomes
• Collaborate with experience quality, training, knowledge management and customer service teams to ensure adoption and
expertise of staff participating in / driving experiences and journeys.
• Manage to administrative financial targets.
• Design and deliver integration with programs including Neighborhood Care, EmblemHealth Solutions at ACPNY/ACPNY Express and Patient Advocate Program (HUB).
Principal Accountabilities
Experience Definition and Implementation:
• Define and deliver Member/Stakeholder Experiences, Journeys including digital, print, and voice channels of static
information, transaction experience and dynamic journeys. Responsible for assessing current state vs future state
experience and defining an achievable project path to implementation and ongoing optimization.
• Develop a member experience roadmap with short term wins, introduction of new capabilities and technology tools;
execute new quality/training/hiring practices with data driven rigor.
Journey Definition and Implementation:
• Architect integrated positive journeys using Member engagement platforms (Call – Genesys, CRM SF
Service/Mktg/CDP/Exp Cloud) along with experience tools, including Adobe Experience Manager (AEM), Salesforce
(Marketing Cloud, Experience Cloud (portals), Service Cloud/Health Cloud, and Consumer Data Platform
segmentation engine.
• Act as product owner for development planning and feature functionality.
• Develop and recommend tele-sales strategy, providing options for consideration leveraging staff augmentation vs a
fully insourced model. Implement and drive for positive results.
Health Payer /Quality CAHPS:
• Responsible for partnering with the Clinical leadership team to achieve health payer operations including member
satisfaction, retention, and clinical/non-clinical engagement as well as Medicare Stars/Quality/CAHPS metrics.
• Drive performance to exceed industry standards as measured by Net Promoter Score, CAHPs and STARs ratings.
Project Management:
• Render the complex simple by breaking into deliverable pieces and creating incremental value toward final state;
PMO, Communication and coordination.
• Responsible to architect integrated positive experiences and journeys then successfully implement using noted tools,
personnel (call center staff, outreach staff, etc.) and physical/retail assets.
• Develop cost containment/value retention strategies related to stakeholder experience.
Community based outreach/resource exposure and knowledge:
• Create higher engagement levels, completions of journeys as well as higher NPS and continuous engagement /brand
affinity through an understanding of community resources and their role in urban and suburban populations.
• Leverage community resources like EmblemHealth Neighborhood Care and Advantage Care Physicians of NY.
• Define and lead retail Community based staff to deliver on KPIs outlined for that resource.
Collaboration and Cooperation:
• Drive accountability across stakeholders and lead by collaborative example by building relationships, marshalling resources,
communicating barriers and collaborating to deliver on execution and implementation scope, outcomes and timeliness
Education, Training, Licenses, Certifications
• Bachelor’s degree in clinical specialty, healthcare, business, or other related area; Master’s degree in healthcare or business preferred.
Relevant Work Experience, Knowledge, Skills, and Abilities
• 12 – 15+ years’ related experience in positions of increasing responsibility/complexity, including stakeholder experience.
• 5 – 10+ years’ managed healthcare experience.
• Experience articulating a vision, garnering business buy-in, carrying out corporate-wide projects, delegating responsibility,
and holding teams (and oneself) accountable for results.
• Experience managing a diverse and distributed team; ability to manage multiple locations and remote staff.
• Experience in the development and implementation of metrics and analytics to measure performance.
• Ability to interpret & implement federal, state and local guidelines for all aspects of the member and provider processes.
• Proven ability in the development and implementation of metrics and analytics to measure performance.
• Proven experience in cost containment for a large division, department, or company.
• Excellent communication skills (verbal and written) with a proven track record of effectively interfacing, training, presenting
information to multiple levels of the organization.
• Proficient in MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.).
• Ability to work successfully with key stakeholders.
• Understanding of industry regulatory environment and experience working with regulators at the state and federal levels.
• Subject matter expert in insurance operations including enrollment and billing, customer service, medical management, and
claims processing.
• Previous experience with Genesys, CRM SF Service/Mktg/CDP/Exp Cloud
• Previous experience with Adobe Experience Manager (AEM), Salesforce (Marketing Cloud, Experience Cloud (portals), Service Cloud/Health Cloud, and Consumer Data Platform segmentation engine.
Security Disclosure
If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.
Pay Disclosure
At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.
EEOC Statement
We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.
Sponsorship Statement
EmblemHealth may provide work visa sponsorship depending on factors such as business unit requirements, position nature, costs, and applicable laws and regulations.