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.

Leader, Vendor Oversight Management, Call Centers

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Director and Equivalent
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200XJ Requisition #
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Provide thought leadership and performance oversight of outsourced call function vendors.  Calls outsourced to the vendors include, but are not limited to the following:

  • EmblemHealth: Cognizant - all PPO and HMO provider calls, HMO member calls (Medicare, Medicare, Commercial) and RX Customer Service for select lines of business; ESI; HCP; DentaQuest; Evicore; EyeMed; Beacon.
  • ConnectiCare: Cognizant - all provider calls; Ameridial – overflow for all member calls; DentaQuest – all dental member call
  • ACPNY: Cognizant - overflow of all patient calls

Partners closely with the Vice President, Experience and team, including workforce management, to ensure our vendors understand the “Emblem way”, ensure operational readiness for technology migrations/upgrades and execute in accordance with agreed upon service level agreements. For instances where the vendor fails to deliver, work with the Relationship Manager and create and execute a corrective action plan, then monitor to ensure effectiveness.


Responsibilities: 

  • Provides direction, insight and communication of business priorities and experience to vendors to ensure alignment with the vision and goals for the member/providers/patients of those they serve.
  • Coordinates day to day performance for all outsourced Call Center work to ensure adherence with quality and serve level expectations and contractual obligations.  Emphasis to be placed on quality and experience
  • Validates and verifies performance results through audits, including calibration sessions and  review of formulas leveraged to calculate results
  • Drives operational improvements plans, with an emphasis on trends, root cause analysis and customer centric metrics.  Evaluate why individuals are calling and determine ways modify upstream processes that avoid the need for calls and develop outreach campaigns in partnership with the Experience team.
  • Ensures operational readiness for all technology, policy and process changes
  • Partners with internal stakeholders to ensure end to end alignment and response time so members/providers and patients receive timely resolution to their needs

  

Qualifications:

  • 4 year degree in business or related discipline; additional years of experience may be used in lieu of educational requirement
  • 10 – 12 years’ related business experience 
  • 5 years’ experience in positions designed to drive business performance improvement on a fulltime basis 
  • 7+ years in process improvement/re-engineering (i.e., Supply Chain Management, Business Process Management, Industrial Engineering, etc.); or 1+ years of relevant experience, after receiving related certification
  • Working knowledge of Vendor Operations and experience leading large-scale operations
  • Proven track record of effective vendor oversight management

 

 

 

 

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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