Outbound Call Center Director

Regular Exempt GENERAL DESCRIPTION: Direct and oversee the strategy, performance, and continuous improvement of Customer Retention, Customer Success, and Customer Resolution operations. Responsible for driving member satisfaction, loyalty, retention, service recovery, and operational excellence through inbound and outbound call center initiatives. Ensure compliance with applicable federal and state regulations while achieving organizational objectives related to customer experience, Stars performance, membership growth, retention, quality, and operational efficiency. ESSENTIAL FUNCTIONS:
• Directs, monitors, and oversees the outbound call center's operations, including the delegation applicable to the delegated entities, tracking performance metrics as outlined in the performance guarantees and reporting those metrics to various stakeholders, forums, and committees.
• Provides strategic leadership and operational oversight for the Customer Retention, Customer Success, and Customer Resolution teams, ensuring alignment with organizational goals and member experience objectives.
• Develops and executes customer experience, loyalty, retention, and service recovery strategies that improve member satisfaction, engagement, and retention outcomes.
• Establishes, monitors, and analyzes operational metrics, service levels, quality indicators, customer satisfaction measures, retention performance, and other key performance indicators (KPIs).
• Partners with internal departments and delegated entities to identify and implement solutions that enhance member experience, close service gaps, and improve operational effectiveness.
• Directs the development and execution of special initiatives, campaigns, and programs focused on retention, loyalty, Stars performance, Consumer Assessment of Healthcare Providers and Systems (CAHPS) impact, membership growth, and customer engagement.
• Ensures timely and effective resolution of escalated member issues, complaints, referrals, and service recovery opportunities while promoting closure of the service cycle.
• Identifies trends, root causes, and improvement opportunities through data analysis, call center top reasons and customer feedback, implementing action plans that drive measurable results.
• Oversees workforce planning, budgeting, resource allocation, vendor management, and organizational readiness to support operational demands and service objectives.
• Develop operational documentation such as policies and procedures (P&Ps), standard operating procedures (SOPs), and Business Continuity Plan (BCP) to ensure that operations comply with internal and regulatory requirements and processes are effectively in place.
• Ensures compliance with the Center of Medicare and Medicaid Services (CMS), Office of the Commissioner of Insurance (OCS), Health Insurance Portability and Accountability Act (HIPAA), and other applicable regulatory requirements, as well as company policies, procedures, and quality standards.
• Supervises, monitors, trains, evaluates, and corrects personnel among others to comply with his/her role as a supervisor, to assure that his/her personnel fulfill their work plan and comply with their essential functions and that they behave following the policies, standards, norms, and procedures of the Company.
• Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
• May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document. MINIMUM

QUALIFICATIONS:
Education and

Experience:
Master’s Degree in Marketing, Communications, Business Administration, Operations Management, or related fields. At least five (5) years of experience in leading retention, customer success, customer resolution, member experience, and service recovery programs; developing and monitoring operational metrics, KPIs, workforce planning, and performance improvement initiatives. Experience within the healthcare industry preferred. At least two (2) years of experience supervising personnel. OR Education and

Experience:
Bachelor’s Degree in Marketing, Communications, Business Administration, Operations Management, or related fields. At least seven (7) years of experience in leading retention, customer success, customer resolution, member experience, and service recovery programs; developing and monitoring operational metrics, KPIs, workforce planning, and performance improvement initiatives. Experience within the healthcare industry preferred. At least four (4) years of experience supervising personnel. “Proven experience may be replaced by previously established requirements.” Certifications / Licenses: Not required. Other: N/A Languages: Spanish – Advanced (comprehensive, writing and verbal) English – Advanced (comprehensive, writing and verbal) “We are an Equal Employment Opportunity Employer and take Affirmative Action to recruit Protected Veterans and Individuals with Disabilities.”