VP, Member Experience

Highmark Health•Washington, DC

1d•Onsite

About The Position

This role is accountable for orchestrating the strategic vision and operational excellence of member experience through effective service delivery and robust appeals & grievances management and the efficient deployment of service resources to consistently improve customer-impacting performance. The role champions transformational innovation, leverage strategic partnerships, and cultivate a high-performing workforce to ensure regulatory compliance, achieve market differentiation, and deliver sustained growth.

Requirements

Bachelor's Degree Business Administration or Health Care Administration
10 years in a management role in Healthcare, Insurance or Financial services with experience in driving change and process improvements
10 years of evaluating technology for implementation
10 years of utilizing insurance principles, industry practices, operational and system processes, quality control techniques, resource management and financial management skills
7 years of utilizing various industry laws and regulations such as HIPAA, Sarbanes Oxley compliance, Act 68 and Act 147
Demonstrated ability to develop and maintain strong working relationships with colleagues at different levels of the business, including senior levels within the enterprise
Demonstrated excellent organizational skills, strong analytical and conceptual skills, and solid financial analysis skills coupled with demonstrated problem-solving skills
Solid negotiation and influencing skills

Nice To Haves

7 years in a call center environment
7 years of broad knowledge of operations, including various aspects of member and provider service and experience.

Responsibilities

Provide executive oversight and strategic direction across critical operational functions, encompassing Enrollment & Billing, Member Engagement Centers, sophisticated Appeals & Grievances processes, and comprehensive Workforce Management, ensuring regulatory compliance and superior member experience.
Lead the strategic development and flawless execution of all member related operational initiatives, driving excellence in Quality, and operational analytics, across all relevant lines of business. This includes strategic enablement for Health Plan Operations (HPO) and supporting enterprise-wide transformational initiatives.
Formulate and champion a comprehensive operational strategy, ensuring enterprise-wide understanding and robust execution by operational leadership to achieve strategic objectives, guiding service operations and managing project lifecycles for high-impact results.
Cultivate strategic partnerships with senior leadership across various segments and operational divisions, drive the successful implementation of critical initiatives and ensure exceptional account and customer satisfaction through effective operational administration, including premier accounts and strategic FBOA services.
Accountable for cultivating a high-performing team, optimizing productivity and fostering a culture of continuous improvement while simultaneously driving efficiency and cost-effectiveness.
Translate overarching business vision and corporate strategy into actionable operational tactics, while assessing the organizational support and infrastructure to realize these strategic imperatives.
Define and implement strategic goals, programs, and best practices, leading continuous improvement initiatives and ensuring unwavering adherence to all compliance standards across operational functions, including the oversight of specialized service units such as dedicated pharmacy operations.
Drive significant advancements in operational performance, productivity, and customer service effectiveness, consistently delivering on our value proposition to members and regulators, and enhancing revenue management to decisively differentiate our organization within the industry.
Achieve unparalleled operational excellence across both internal and outsourced processes, providing strategic support and oversight for core service vendor partnerships to ensure high-performance outcomes, optimized cost models, and strategic alignment of the vendor footprint.
Continuously elevate member satisfaction targets through dedicated improvement programs, proactive support, and personalized engagement across all member segments.
Guide the strategic vision and oversee the implementation of innovative, real-time operational solutions and advanced self-service capabilities, including leveraging Artificial Intelligence and global delivery models to evolve the future of customer engagement and operational workflows.
Provide executive leadership to comprehensive day-to-day operations, striving to achieve and sustain top-tier performance among industry peers and competitors.
Other duties as assigned or requested.