Job description

Summary of Position

• Promote quality achievement and performance improvement throughout the organization.
• Frequently interface with and direct quality management counterparts or vendors to continuously improve performance for claims, customer service, provider service, enrollment and billing, and medical and pharmacy core processes; and to achieve end-to-end results across the EmblemHealth value stream.

• Implement statistical process control on critical quality metrics by overseeing various initiatives to improve our member experience in alignment with the mission and vision of our companies.Principal Accountabilities

• Lead a team of Quality Analysts that assess, evaluate, and implement scalable and efficient process redesigns that improve member experience and align to operational metrics.

• Work to update and develop complex processes; coordinate end to end solutions with internal stakeholders.
• Direct and manage vendor quality operations by conducting capability analyses, transactional audits, quality program verifications, compliance reviews and customer experience surveys.

• Engage and lead daily or weekly huddles, transactional reviews, corrective action drilldowns and call calibrations with quality counterparts

• Drive transformational quality initiatives through growth development, and application of systemic Problem Solving and Process Improvement.

• Develop and maintain appropriate relationships with all stakeholders to facilitate the successful accomplishment of key quality initiatives.

• Mentor and lead team members to review, analyze and report statistical findings through critical thought and clearand concise reporting of key findings and opportunities to all levels within the organization.

• an understanding of current state process, analyze processes, data and systems- identify improvement opportunities and make recommendations based on audit results.

• Partner with Operations stakeholders to share data analysis, future state process, re-designs and quantified process improvement implementation recommendations.Education, Training, Licenses, Certifications

• Bachelors’ Degree, preferably in Healthcare, Business, or related quantitative field of study.

Relevant Work Experience, Knowledge, Skills, and Abilities

• 5 – 8+ years of relevant, professional work experience required
• Experience in Quality Management and Improvement, Change Management, and Customer Experience required
• Additional experience/specialized training may be considered in lieu of educational requirements required
• Energy, drive and passion for End-to-End excellence and customer experience improvement required
• Excellent collaboration skills and the ability to influence management decisions required
• Strong problem solving and analytical skills that can be applied across all types of business problems required
• Strong facilitation, verbal and written communication and presentation skills required
• Solid coaching and mentoring skills to continuously develop staff core competencies at vendors required
• Demonstrated Customer Experience focus and 1 year of process improvement experience required

Additional Information

• Requisition ID: 1000000589
• Hiring Range: $90,000-$110,000

Job Type: Full-time

Pay: $90,000.00 - $110,000.00 per year

Schedule:

• 8 hour shift

Experience:

• Quality Assurance Management and Improvement : 5 years (Required)

License/Certification:

• Quality Certification (Preferred)

Work Location: Remote

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