- EmblemHealth: Cognizant - all PPO and HMO provider calls, HMO member calls (Medicare, Medicare, Commercial) and RX Customer Service for select lines of business; ESI; HCP; DentaQuest; Evicore; EyeMed; Beacon.
- ConnectiCare: Cognizant - all provider calls; Ameridial – overflow for all member calls; DentaQuest – all dental member call
- ACPNY: Cognizant - overflow of all patient calls
Partners closely with the Vice President, Experience and team, including workforce management, to ensure our vendors understand the “Emblem way”, ensure operational readiness for technology migrations/upgrades and execute in accordance with agreed upon service level agreements. For instances where the vendor fails to deliver, work with the Relationship Manager and create and execute a corrective action plan, then monitor to ensure effectiveness.
- Provides direction, insight and communication of business priorities and experience to vendors to ensure alignment with the vision and goals for the member/providers/patients of those they serve.
- Coordinates day to day performance for all outsourced Call Center work to ensure adherence with quality and serve level expectations and contractual obligations. Emphasis to be placed on quality and experience
- Validates and verifies performance results through audits, including calibration sessions and review of formulas leveraged to calculate results
- Drives operational improvements plans, with an emphasis on trends, root cause analysis and customer centric metrics. Evaluate why individuals are calling and determine ways modify upstream processes that avoid the need for calls and develop outreach campaigns in partnership with the Experience team.
- Ensures operational readiness for all technology, policy and process changes
- Partners with internal stakeholders to ensure end to end alignment and response time so members/providers and patients receive timely resolution to their needs
- 4 year degree in business or related discipline; additional years of experience may be used in lieu of educational requirement
- 10 – 12 years’ related business experience
- 5 years’ experience in positions designed to drive business performance improvement on a fulltime basis
- 7+ years in process improvement/re-engineering (i.e., Supply Chain Management, Business Process Management, Industrial Engineering, etc.); or 1+ years of relevant experience, after receiving related certification
- Working knowledge of Vendor Operations and experience leading large-scale operations