Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.

Position Summary

The position of Senior Director, Member and Provider Services is responsible for the success and oversight of inbound and outbound customer service functions supporting members and providers for Martin’s Point Health Plan lines of business. In this role the Senior Director, Member and Provider Service will plan and execution strategies which deliver service value to Martin’s Point Health Plan members and providers; the identification & implementation of activities contributing to customer and stakeholder satisfaction, retention, and loyalty; improved operational efficiencies; and continued compliance with our Centers for Medicare and Medicaid Services (CMS) and Department of Defense (DOD) contracts.

Job Description

Key Outcomes:

• Leads the development and execution of customer service strategy for Martin’s Point Health Plan that aligns with the organizational customer service and experience strategy.

• Provides input for as well as building operational readiness plans to support corporate wide initiatives impacting customer satisfaction and operational effectiveness activities.

• Partners with network management to develop a comprehensive range of support for providers including inbound and outbound calling, escalation, and relationship management.

• Establishes, oversees, and develops accountability for performance metrics to ensure the highest level of service is delivered to Martin's Point Health Plan members and providers, effective and efficient processes are in place, and all regulatory and compliance standards are met.

• Oversees development of organizational campaigns for both inbound and outbound calling

• Supports member education and engagement programs for new & current members (e.g. Welcome Call Program, Member Education Materials, Member Seminars, Service at MPHC Practices, etc).

• Oversees, enhances, and maintains reporting and audit mechanisms to ensure compliance with regulatory requirements; oversees sophisticated short and long-term forecasting and workforce management strategy.

• Collaborates with direct reports and other leaders in the development and execution of training, audit, and compliance programs to ensure department activities are delivered in an accurate and efficient manner.

• Collaborates with Compliance and Product Management teams to ensure their department processes & procedures comply with the regulatory and contractual requirements.

• Collaborates with partner areas including but not limited to marketing, network management and information technology in the identification, selection, and implementation of technological solutions which result in operational efficiencies, improved performance, enhanced self-service and increased satisfaction.

• Develops comprehensive customer and stakeholder self service adoption strategy including development and change control processes, measurement reporting and campaigns for portal, IVR and other technology tools.

• Ensures sound coordination and collaboration with other areas of the organization.

• Maintains expertise in the health care call center industry, tracks key trends, and identifies needed shifts in the Martin’s Point strategy.

Education/Experience:

• BA/BS or equivalent degree required. Master’s degree in related field preferred

• 10 years leadership experience in healthcare customer service

• Experience in a managed care organization with detailed experience in managed care service delivery functions required.

• Proven experience with identifying & executing activities which increase member satisfaction & loyalty as well as improve operational performance and regulatory compliance

• Proven experience in leading self service adoption programs to drive down call volumes.

Skills/Knowledge/Competencies (Behaviors):

• Knowledge of Medicare regulatory requirements.

• Demonstrates an understanding of and alignment with Martin’s Point Values.

• Detail oriented with continuous attention to compliance/contractual requirements.

• Ability to obtain results by managing cross-functional teams outside your direct authority.

• Knowledge and understanding of managed care concepts.

• Ability to work effectively with all levels of board, management, staff, consultants, and vendors.

• Ability to evaluate alternatives and make sound decisions.

• Ability to manage resources across multiple departments to ensure operational levels of performance are consistently met.

• Exceptional communication skills (oral and written).

• Ability to build and manage strong internal and external relationships.

• Ability to translate strategic objectives into specific operational activities which can be executed.

• Ability to plan, organize, and prioritize multiple activities.

• Ability to analyze data, reports, and make recommendations for improved performance.

• Effective team builder, mentor, and coach.

• Ability to solve complex problems.

• Ability to effectively work on multiple activities at one time.

• Flexible, agile and a willingness to rapidly change directions with ease, while maintaining a positive attitude.

There are additional competencies linked to individual contributor, provider and leadership roles. Please consult with your leader to discuss additional competencies that are relevant to your position.

We are an equal opportunity/affirmative action employer.

Do you have a question about careers at Martin’s Point Health Care? Contact us at: jobinquiries@martinspoint.org

Martin’s Point Health Care is a progressive, not-for-profit organization providing care and coverage to the people of Maine and beyond. The organization operates six primary care health care centers in Maine and New Hampshire, accepting most major insurance plans. Martin’s Point also administers two health plans: Generations Advantage (Medicare Advantage plans available throughout Maine and New Hampshire), and the US Family Health Plan (TRICARE Prime® plan for active-duty and retired military families in northern New England, upstate New York, and western Pennsylvania). For more information, visit https://careers.martinspoint.org .