Director Of Operations
Led inbound call center team and back-office organization to support Medicare, Medicaid, and PDP lines of business with one of the nation’s largest Managed Care Organizations. Administered operational budget of $20M. Enabled, facilitated, and empowered teams to deliver exceptional service and quality to members and stakeholders.• Managed team of Project Managers to support new growth opportunities.• Created 'Reach" Program to support outreach to members deemed as “Unable to Contact.” • Drove operational oversight, supporting member experiences, and driving improvements.• Expanded the Presidential / Executive Response Team, responding to CEO, Executive, BBB, DOI, and high-level internal escalations from Corporate and Customer Service channels. Performed root cause analysis and worked with business partners to mitigate future escalations.• Aligned Back-Office Specialty Escalation Teams, addressing urgent member needs via Real-Time-Chat function as well as ticketed submissions via Customer Service. Reduced turnaround times and provided 83% resolution of escalations on the first call and less than 1% rate of complaints.• Coordinated Face-to-Face Interpreter Services, Web Support for Contact Us, Social Media platform responses and back-office member support requests. Improved member experiences with 98% to 99% completion of interpreter services. Consistently met key performance indicators (KPIs) for back-office ticket resolutions. Provided timely Positive Web support metric results to NCQA.• Directed the Quality Auditing Teams supporting Grievance and CTM (Complaint) responses to members, ensuring Quality and Compliance guidelines were met. Consistently achieved Quality KPI goal of 98%.• Empowered the Grievance Governance Analysis Team, focusing on identification of trends and mitigation opportunities from member abrasions which resulted in formal Grievances. Achieved a 31% reduction.• Guided the Corporate Reception Team, managing calls to Centene HQ.
