PacificSource Health Plans

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PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

The Director of Customer Service Operations provides new and existing members as well as providers with the best possible service in relation to general service needs including questions about benefits, billing inquiries, service requests, suggestions and complaints. This position is responsible for managing customer service functions across all business lines and acts as the strategic leader within Operations. Resolves member and provider inquiries and complaints fairly and effectively. Provides product and service information to members and providers, and identifies opportunities to increase membership by improving our member and provider experience. Recommends and implements programs to support member and provider needs. Knows and supports Health Plans in achieving their contractual goals for service and compliance. is responsible for leading and managing the commercial and government customer service department for PacificSource to ensure exceptional service delivery and customer satisfaction. This role involves strategic planning, policy development, performance monitoring, and staff management to drive continuous improvement in customer service operations.

Essential Responsibilities:

• Provide dynamic leadership for Customer Service management team and agents.
• Partners with Product, Marketing and IT departments in order to achieve goals and improve the member and provider experience.
• Strong leader with the ability to develop teams focused on delivering great healthcare service to a population that has often been underserved.
• Directs and coordinates all aspects of Customer Service across lines of business within PacificSource operations through partnerships with other operation teams and departments, as well as development of their own team.
• Communicate operational objectives and initiatives to work units to align with the organizational goals set by senior leadership.
• Develops and executes strategies to achieve goals and enhance customer service standards. Leads a team that consistently meets and surpasses department Key Performance Indicators (KPI), including productivity and service quality targets.
• Drives process improvements to ensure performance standard goals including quality goals are met.
• Leads a team across lines of business to ensure exemplary customer service to all customers including our members, co-workers, vendors, providers, government agencies, business partners and the general public.
• Possesses the ability to distill complex issues and situations into a readily understandable item with recommendations for improvement.
• Develop and implement the strategic vision for the customer service department, across lines of business, by aligning with overall company goals.
• Ensures implementation of customer service policies, procedures, and standards to ensure consistency and quality.
• Participates in audits including state, federal, internal, National Committee for Quality Assurance (NCQA) and Healthcare Effectiveness Data and Information Set (HEDIS) as applicable.
• Oversee the development and preparation of short-term and long-range plans for customer service teams and recommend policy changes to the senior leadership team.
• Oversee the resolution of complex and escalated customer service issues, ensuring timely and satisfactory outcomes.
• Enhances efficiencies while maintaining quality and culture. Drives the adoption of digital tools and technologies to enhance customer service efficiency and satisfaction.
• Responsible for oversight, management, development, implementation, and communication of department programs.
• Responsible for hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback, including regular one-on-ones and performance evaluations, for direct reports.
• Develop annual department budgets. Monitor spending versus the planned budgeted throughout the year and take corrective action where needed.
• Coordinate business activities by maintaining collaborative partnerships with key departments.
• Responsible for process improvement and working with other departments to improve interdepartmental processes. Utilize lean methodologies for continuous improvement. Utilize visual boards and daily huddles to monitor key performance indicators and identify improvement opportunities.
• Actively participate as a key team member in Manager/Supervisor meetings.
• Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy.

Supporting Responsibilities:

• Meet department and company performance and attendance expectations.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

SUCCESS PROFILE

Work Experience: Minimum of seven (7) years of experience in customer service operations required. Prior supervisory experience required. Health insurance experience and advanced skills in medical terminology, CPT / ICD-9 coding preferred. Four (4) years of management experience as an effective and responsive leader preferred.

Education, Certificates, Licenses: Bachelor’s degree in Business or related field required or equivalent education and experience.

Knowledge: Ability to gain thorough understanding of PacificSource products, plan designs, provider relationships, and health insurance terminology. Knowledge of commercial, Medicaid and Medicare health plans. CMS, state-based and federally facilitated marketplaces, and state regulation strongly preferred. Basic understanding of claims processing system and operation. Consistently helpful, confident, and pleasant with all types of customers, both internal and external. Relationship skills and leadership qualifications. Ability to clearly communicate with co-workers and takes proactive, as well as responsive, action to ensure good service. CPT/ICD-9 coding and medical terminology experience or education preferred. Ability to read and understand health contract and benefits language. Ability to work under time pressures and deal with difficult situations. Ability to define and prioritize problems and manage workload without direct supervision. Ability to read and understand health contracts and benefit language.

Competencies

Authenticity

Building Organizational Talent

Coaching and Developing Others

Compelling Communication

Customer Focus

Empowerment/Delegation

Emotional Intelligence

Leading Change

Managing Conflict

Operational Decision Making

Passion for Results

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time.

Skills:

Accountable leadership, Business & financial acumen, Empowerment, Influential Communications, Situational Leadership, Strategic Planning

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.
• We are one team working toward a common goal.
• We are each responsible for customer service.
• We practice open communication at all levels of the company to foster individual, team and company growth.
• We actively participate in efforts to improve our many communities-internally and externally.
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.