VP Member Experience - Gateway Health Plan

Job ID: J117063
Company: Gateway Health Plan
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Feb 22, 2018

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Description

JOB SUMMARY:

This job is the executive owner driving all elements of the member experience.  The role is responsible for leadership in every phase of the member’s nonclinical experience, from the initial “Gateway to Care” welcome call to the successful resolution of appeals and grievances.

The VP, Member Experience devises and delivers the service delivery strategy as well as owns operational responsibility for all areas touching the non-clinical member experience including but not limited to:

  • Inbound call centers including pharmacy support and services, provider services, member services, member retention and non-clinical care and utilization management support services.
  • Outbound call centers encompassing member retention, provider relations and outbound call campaign support, relieving the need to utilize third party sources for these campaigns.
  • Appeals and Grievance resolution
  • Integration and implementation of Long Term Support Services (LTSS) call center capacities
  • Member incentive program management
  • Implementation and administration of member engagement committees/focus groups
  • Operational implementation of member profile, member portal, interactive voice response (IVR) system, electronic outreach and other emerging technologies impacting the member experience in partnership with IT and the Data Analytics Warehouse. 

Additionally, In support of Gateway’s future expansion, the VP Member Experience and the ME Team will work to promote member-facing initiatives that ensure Gateway’s competitiveness in new markets. Utilizing data from gDNA and other behavioral resources, the ME area will construct engagement initiatives that support and promote Gateway’s quality and care management activities.   The ME team is comprised of specialists in member experience and engagement who work collaboratively with the quality and care management areas to develop programs driven by behavioral science and economic principles which will engage members in their care, motivate them to adopt behaviors which will improve their health outcomes, and construct member experiences which support them in these initiatives.

The team is also responsible for devising technology strategies which consistently engage members utilizing emerging technologies, lessening dependence on employee resources and increasing measurable and financially efficient results.

ESSENTIAL RESPONSIBILITIES:

Provide oversight for operations and strategic activities related to service delivery functions including Customer Service Center (inbound and outbound call center activities).  Deliver achievement of contractually required SLAs and KPIs while also ensuring the operations support the strategic goals of the member experience including supporting care management, member retention and quality goals.

Oversight for Appeals and Grievances Unit ensuring compliance with regulatory requirements for all A&G operations. 

Operational leader for Customer 360 initiative in support of Gateway operational focus areas:  implementation of member profile, member portal, interactive voice response (IVR) system, electronic outreach and other emerging technologies impacting the member experience in partnership with IT and the Data Analytics Warehouse. 

Oversees Process Readiness and Audit Readiness functions and ensures implementation and adherence to government regulations and development and implementation of corrective action plans, policy and procures and process improvements.

Act as executive advocate ensuring positive member experiences while simultaneously providing feedback on issues impacting member satisfaction as determined through direct contact in focus groups, service center calls, and portal contacts.

Lead strategy and initiative development and operational implementation of member experience and engagement initiatives which support Gateway’s objectives and delivers on the promise of an exceptional member experience.  Executive responsible for the Member Experience (ME) Team comprised of member experience and behavioral science specialists focused on constructing a member experience which drives the member to better health outcomes through engagement.

Lead the cultural transformation of member-centered service which builds on the member-centric clinical efforts already underway.

QUALIFICATIONS:

Minimum:

  • Bachelor’s degree
  • Four (4) years’ experience in service management
  • Seven (7) – ten (10) years of experience is required in health insurance industry in variety of areas
  • Increasingly responsible operational experience to include service delivery

Preferred:

  • Master’s degree

SKILLS:

  • In-depth knowledge of operations and service delivery
  • Excellent written and spoken communications skills
  • Must possess strong leadership and interpersonal skills
  • Expertise in the health insurance industry
  • Consulting experience in implementation and optimization engagements
  • Strong technical background, including knowledge of major systems vendors
  • Transformation leadership experience with emphasis on cultural change

SCOPE OF RESPONSIBILITY

Does this position supervise others?

Yes

TRAVEL REQUIREMENT:

None

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
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For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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