Position Description

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.” 

As the Director of Member and Provider Customer Service, you will be responsible for:

• Engaging the organization in managing customer relationships, revenue, and profit.
• Creating a persistent focus on the customer in the actions the company takes.
• Driving the organization to work together for optimum customer experience delivery.
• Establishing metrics for defining the relationship with customers.
• Creating a united platform for understanding and taking action.
• Defining what customers value and determining the differentiating experience to be delivered.
• Deciding where to make investment decisions, that is, the highest-impact contacts and efforts.
• Drive accountability through cross-company data and metrics, in partnership with leadership.
• Facilitating the development of the accountability action chain, establishing the approaches and implementation of research to understand customer loyalty and return on investment.
• Working with leaders to identify baseline metrics for tracking interaction with customers.
• Driving tracking and reporting to get to reliability in key interactions.

Responsibilities and Qualifications

• Develop and maintain a staff of personnel that is capable of handling Customer Service interactions in an effective and efficient manner. Continually evaluate the personnel and organizational structure of Customer Service Operations, assessing strengths and weaknesses and implement necessary changes and improvements. Manage Customer Service operations in a manner consistent with maximizing productivity while maintaining the highest possible quality standards. Effectively integrate all areas of Customer Service in order to utilize existing expertise, provide specialized service where needed and develop overall flexibility which ensure responsiveness to normal workflow peaks and troughs and the rapidly changing environment in which Customer Service functions.
• Perform short term and long-term planning in order to provide direction for the Customer Service organization. Participate in Corporate-wide projects in order to provide Customer Service input and ensure consideration of what impact the projects might have upon customers and the operations. Maintain effective liaison with all departments within Capital Blue Cross, with Pennsylvania BlueShield, and with governmental entities, i.e. State Insurance Department, Health Care Finance Administration, etc.
• Ensure timely effective response to all inquiries with emphasis upon courtesy, accuracy, completeness, and overall customer satisfaction. Involves the following: Implement effective communications techniques that are designed to: Keep all Customer Service personnel up to date on all policies and procedures that affect customers. Ensure efficient retrieval of information needed to respond to inquiries. Provide Customer Service. personnel with information that can be clearly and consistently transmitted to customers. Ensure that all Customer Service personnel: Receive effective training. Understand the importance of developing and utilizing a positive Customer Service attitude. Have the opportunity to achieve job satisfaction. Receive accurate and timely performance appraisals.
• Evaluate and procure, as needed, state-of-the-art systems, equipment, etc. ensure the needed operational and technical support for all areas of Customer Service. Perform effective analysis by utilizing the information available through regular Customer Service operations to: Evaluate the effectiveness of existing policies and procedures. Identify problem areas requiring corrective action. Provide customers with selective data. Improve processes throughout the service delivery end to end process.
• Responsible for providing a positive customer experience to all customers, group members, providers, and brokers through all communication channels offered; web, phone, IVR, correspondence, and/or social media. Represent the customer in the development of all outbound communications to ensure a positive customer experience is delivered consistently.

Skills:

• Ability to coordinate and control diverse functions and areas of job knowledge within Customer Service (e.g., Claims, Marketing, Vendors, Enrollment & Billing, etc.) and provide effective direction of the activities involved.
• Ability to effectively communicate verbally and in writing at all levels within the organization.
• Ability to promote and maintain positive employee attitudes, stability and experience within the Customer Service workforce.
• Ability to lead, motivate, appraise personnel, and develop subordinates in all areas of management.
• Ability to identify and resolve inter-departmental and inter-plan processing and communications problems that adversely impacts customers.

Knowledge:

• Knowledge of management tools as aids in improving and controlling operations, i.e. budgeting techniques, work management, effective reporting with an emphasis on scheduling and forecasting, etc.
• Knowledge of organization structure and techniques that are designed to achieve accountability, effective workflow, flexibility, etc.
• Knowledge of state-of-the-art telecommunications systems and web interactions, e.g. Automatic Call Distributors (ACDs), Interactive Voice Response (IVRs), call recording, etc.
• Knowledge of Capital Blue Cross and CMS policies and procedures.
• Knowledge of management techniques in areas such as planning, personnel administration, control, etc.

Experience:

• 7 years of work experience in large scale, multi-functional, customer service operations required
• 3 years of staff, team lead or project lead experience required
• 3 years of health insurance experience required

Education:

• Bachelor’s degree preferred

Location:

• This position is classified hybrid, which requires onsite work on Tuesdays and Wednesdays. 

Physical Demands:

While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must be able to work over 40 hours per week. The employee must occasionally lift and/or move up to 5 pounds.

About Us

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a diverse and caring team of supportive colleagues, and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.