Director, Member Service

Job ID: J119183
Company: Highmark Inc
Location: Wilkes-Barre, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at:

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Description

JOB SUMMARY

This job is responsible for the overall service operation supporting the Organization's Member community across a wide range of products and lines of business.  This includes support for telephonic inquiries that customers may utilize to obtain service through Highmark.  Handles, services and completes end-to-end service escalations from the Member community.  Builds key partnerships with the sales and account management team, and creates and maintains relationships with them to establish key strategies, builds trust, aligns with the broader Highmark objectives and prepares to execute other key strategies that may originate from the sales or account management team(s).  Directs and oversees site labor relations programs, policies, and procedures. Responsible for overall employee engagement, driving a culture of world class service, and ensuring employee recognition and reward programs align with our Core Behaviors and overall mission and vision. Develops strategic planning and goals that set appropriate targets of execution for work processes within the business unit to meet performance goals and drive strategic change.  Builds key partnerships with other Health Plan Operations support staff to drive operational efficiencies and best in class platform capabilities.  Acts as the primary contact representing the organization for FEP and related issues; is accountable for communications and decisions related to FEP and other inter-Plan functions; ensures the Plan is maximizing the value of FEP to all constituents including other Blue Plans, members and accounts.  Directs and oversees site labor relations programs, policies, and procedures. Negotiates bargaining agreement. Establishes and maintains satisfactory labor-management relations, interprets the collective bargaining agreements, administers grievance procedures including arbitration, and assists all levels of management on labor matters.

ESSENTIAL RESPONSIBILITIES​

  • Perform management responsibilities including, but not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.  Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
  • Direct the daily production activities of staff member to deliver accurate, timely and efficient service to customers.  Including establishing goals, monitoring performance, and delivering world class service.  This would include setting goals, building the necessary scorecards and performance monitoring tools, and ensuring the communication and transparency of key departmental results.
  • Establish a clear strategy to drive the overall effectiveness of Highmark's Member service function.  Create a culture of world class service and enhance/develop policies and procedures of the department that will improve the overall operation and service delivery.
  • Ensure all operational processes are in compliance with established quality standards, government and industry regulations, and client requirements. 
  • Develop and execute a hiring plan and overall growth strategy, in partnership with the Command Center.  Ensure that high quality employees are sourced, hired and successfully onboarded and provide mechanisms and programs for coaching, mentoring, and overall career progression.  
  • Maintain and establish an experienced leadership team through the coaching, support, mentoring and training of direct reports in key leadership roles.  
  • Provide significant input and direction to the development of future operational capabilities by evaluating, investigating and recommending newly defined systems, process and techniques.  This should include identifying opportunities to drive operational efficiencies, automation and first call resolution.
  • Creating an "easy" customer experience:  Build an overall environment and culture focused on improving processes, driving efficiencies and delivering world class customer service - improving first call resolution, reducing and eliminating call volume, and improving processes to ultimately achieve an "easy" customer experience.
  • Coordinate time-sensitive FEP Technology software implementations and new functionalities; support and promote all Inter-Plan Programs performance measurements and ensure action plans are in place, as needed. Support BCBSA and Plan efforts in submitting additional data and information; distribute BCBSA communications to appropriate individuals.
  • Ensure Plan staff is educated on all FEP issues that affect their job performance; periodically meet with Plan staff responsible for major FEP functions to communicate and exchange information on FEP initiatives; review, analyze and provide impacts for all Workgroup and Committee Materials; represent the company on BCBSA workgroups or other Interplan workgroups to ensure new projects are strategically aligned with our National business.
  • Coordinate local level negotiation and participates in negotiation of agreements. Advise location human resources managers and line management on how to handle specific labor relations problems. Handle grievances and serves as the organization's arbitration representative. Ensure compliance with contractual agreements. Maintain informal communications with union leadership on a continuing basis.
  • Other duties as assigned or requested.

EDUCATION

Required

  • Bachelor's Degree in Business Administration/Management, Health Administration or Finance

Substitutions

  • 6 years of experience or similar degree

Preferred

  • Master's Degree

EXPERIENCE

Required

  • 7 - 10 years in a Call Center
  • 5 - 7 years in Management

Preferred

  • 10 - 15 years in Customer Service
  • 7 - 10 years in Leadership
  • 3 - 5 years in Lean/Six Sigma

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 job 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)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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