- Company Name
- Alignment Health
- Job Title
- VP, Member Experience
- Job Description
-
**Job Title**
VP, Member Experience
**Role Summary**
Lead and optimize all member experience functions, including inbound/outbound call centers, appeals, grievances, and vendor management. Design and execute engagement strategies to enhance member satisfaction, retention, and alignment with the "Senior First" mission. Report to COO, collaborate across departments, drive analytics, and oversee continuous quality improvement.
**Expectations**
- Deliver measurable improvements in member engagement, satisfaction, and retention.
- Execute Care Navigation strategy and technology implementation (CRM, telecommunication, analytics).
- Maintain high-quality customer service standards and efficient operational workflows.
- Lead appeals and grievances program to reduce overturn rates and drive quality initiatives.
- Support COO with strategic planning, budgeting, and performance reporting.
- Drive innovation in process automation and data integration.
**Key Responsibilities**
- Oversee internal teams and outsourced partners for call center, appeals, grievances, and BPO operations.
- Design, implement, and test proactive/reactive engagement initiatives.
- Strategically manage care navigation projects, including CRM and telecommunications.
- Analyze outcome metrics, report results, and recommend improvements.
- Lead quality improvement initiatives to reduce overturned appeals & grievances.
- Innovate workflow, automation, and system integration to maximize investments.
- Ensure staff customer-service orientation, compliance with quality standards, and operational efficiency.
- Resolve quality/service issues and implement remediation plans.
- Build collaborative culture and facilitate solutions across departments.
- Report standard member experience metrics and recommend strategy adjustments.
- Handle recruitment, training, workload assignment, performance management, and coaching of direct reports.
- Travel as required.
**Required Skills**
- 10+ yrs in consumer/member experience in healthcare; 5–7 yrs in call‑center leadership.
- Expertise in Medicare appeals and grievances (preferred).
- Strong analytical skills with experience using CRM, analytics, and reporting tools.
- Proven ability to streamline operations, manage efficiencies, and automate workflows.
- Strategic thinking, forward‑looking mindset, and change‑management capability.
- Effective leadership: team building, coaching, performance appraisal.
- Excellent communication: persuasive presentation to detail‑level and executive audiences.
- Interpersonal skills for stakeholder engagement and collaboration.
**Required Education & Certifications**
- Bachelor’s degree (BA) from a four‑year institution or equivalent combination of education and experience.
- Master’s degree (MA) preferred.
- Relevant certifications in healthcare operations, quality management, or customer experience (e.g., Six Sigma, CCA, CPAP, etc.) are a plus.