Job Specifications
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
Position Summary
Responsible for managing internal teams and outsourced partners including inbound and outbound call, Appeals and Grievances and BPO vendor oversight. Create and implement member engagement strategies (Proactive and reactive) that will drive retention and increase member satisfaction.
The VP, Member Experience is a hands-on leadership position reporting directly to the COO. This role will:
Design and deliver key initiatives to continuously reinforce and strengthen Alignments “Senior First” mission that translate to strong member engagement, overall satisfaction, and retention.
Execute Alignments Care Navigation Strategy & technology deployment.
Test and evaluate member engagement approaches to ensure Alignment drives broad and active engagement across various programs and key initiatives.
Collaborate closely with key internal partners to ensure that members remain at the center of everything we do.
Assist the COO in the implementation of strategic & business plans including planning and budgeting activities.
Examine, interpret, and report results of analytics and outcome-based measures.
General Duties/Responsibilities (May Include But Are Not Limited To)
Responsible for refining and executing Care Navigation strategy including customer developed CRM, telecommunication platform and analytics to deliver member insights and actions.
Leads teams focused on member experience across the Enterprise.
Strategizes, executes, and manages in-house and outsourced operations to ensure optimal efficiency, data integrity, and service.
Leads Appeals and Grievances program with a focus on continuous quality improvement and effectiveness.
Analyzes results and leads Quality initiatives to reduce the number of overturned appeals and grievances.
Seeks ways to innovate workflow process improvements and automation of the data environment while maximizing system investments and integration.
Ensures strong customer service orientation of staff and ensures market needs are meeting stringent quality standards while ensuring efficiency and effectiveness of departments.
Develops & implements plans to resolve and remediate quality or service issues related.
Ensure a collaborative environment within the department and organization to facilitate solutions and optimal performance.
Accountable for the identification and implementation of strategies to promote member engagement and retention.
Establish and manage processes to regularly report standard metrics related to member experience.
Requires some travel.
Performs other related duties as assigned.
Supervisory Responsibilities
Oversees assigned staff. Responsibilities include recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and disciplining employees.
Ensure the team is structured appropriately to meet key priorities; assesses skill level to ensure team members are in the right roles, supporting skill development as needed.
Minimum Requirements
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Minimum Experience
Minimum 10 years of consumer / member experience in a healthcare environment.
5-7 years of Call Center experience.
Education/Licensure
Medicare Appeals and Grievances experience preferred
Bachelor's Degree (BA) from four-year college or university, or one to two years of related experience and/or training, or equivalent combination of education and experience.
Master’s Degree (MA) preferred.
Other
Demonstrated track record of generating results and having an impact on organizations.
Proven success streamlining operations and experience running efficient operations is a plus.
Strategic and forward-thinking mindset.
Strong leadership skills with the ability to develop teams.
Innovative in problem solving, planning, and strategizing.
Articulate & persuasive in preparing / presenting business-case for change-management, including at both detailed and executive level where required.
Effective interpersonal skills to consistently demonstrate ex
About the Company
Alignment Health is redefining the business of health care by shifting the focus from payments to people. We've created a new model for health care delivery that cuts costs and improves lives by unraveling the inefficiencies of the current system to drive patients, providers and payers toward a common goal of wellness. Harnessing best practices from Medicare Advantage, our innovative data-management technology allows us to commit to caring for seniors and those who need it most: the chronically ill and frail. Alignment Healt...
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