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WellSense Health Plan · 3 days ago

Director, Member and Provider Service Contact Center

Boston, MA

Contract

Hybrid

Director/Executive

$108K/yr - $157K/yr

10+ years exp

WellSense Health Plan is a growing regional health insurance company with a 25-year history of providing health insurance that works for its members. The Director of Member and Provider Service is responsible for overseeing and evolving the contact center operations, ensuring high-quality service while driving continuous improvement through data and technology.

Hospital & Health Care

No H1B

Responsibilities

Provide strategic and operational leadership of the Member and Provider Service Contact Center, ensuring delivery of accurate, empathetic, and timely service experiences

Develop and execute multi-year plans to evolve the contact center from a transactional model to a proactive, relationship-driven, omnichannel experience

Implement innovative tools (AI, chatbots, voice analytics, CRM systems, etc.) to optimize performance, reduce effort, and personalize service

Identify and lead service improvement initiatives using Voice of the Customer (VoC), root cause analysis, and customer journey mapping

Partner with Workforce Planning and Recruiting to maintain appropriate staffing across lines of business to ensure optimal service levels and adherence to regulatory requirements

Utilize real-time and historical analytics to optimize performance, forecast demand, and drive process improvements

Lead employee engagement, retention, and development strategies through coaching, performance management, and robust career pathing

Foster a culture of accountability, recognition and high performance aligned with company values and a customer-first mindset

Build and manage annual budgets, providing sound business cases for capital investments, organizational alignment and staffing resources

Collaborate with internal business partners to support corporate objectives, customer needs and regulatory requirements

Ensure full adherence to federal and state regulatory requirements, including those from CMS, EOHHS, DHHS, NCQA, and contractual obligations

Lead the development and documentation of operational policies, procedures, and business continuity plans

Serve as the executive point of contact for member advisory committees, public forums and partner feedback loops

Qualification

Healthcare ManagementContact Center OperationsCustomer Experience (CX)Data AnalyticsRegulatory ComplianceAI TechnologiesOmnichannel StrategyTalent DevelopmentContinuous ImprovementResilienceLeadershipCollaboration

Required

Bachelor's degree in Business Administration, Operations, Health Care Management, or related field required

Minimum 10 years of progressive leadership experience in a contact center/customer service environment, including at least 5 years in a healthcare or managed care setting

Deep knowledge of Medicaid/Medicare operations, service delivery models, contact center metrics, contact center channels, telephony and CRM platforms

Demonstrated success in leading transformational initiatives including digital enablement, omnichannel strategy, and automation

Demonstrated improvement in customer experience, employee satisfaction, contact center efficiencies and operational performance

Experience managing within regulated environments and responding to audits, compliance reviews and performance guarantees

Customer-Centric Leadership: Committed to delivering exceptional experiences through empathy, innovation, and a strong operational focus

Continuous Improvement Mindset: Proactively identifies opportunities to streamline processes, enhance performance, and elevate service quality in dynamic, high-volume environments

CX & Tech Fluency: Deep understanding of contact center technologies including ACD, IVR, cloud-based solutions, AI chat, real-time analytics, and WFM platforms

Strategic Execution: Results-driven with strong business acumen; adept at aligning service operations with organizational goals to drive measurable outcomes

Regulatory Insight: Well-versed in applying federal and state healthcare regulations to ensure compliance and operational integrity

Resilience & Agility: Thrives under pressure and effectively manages competing priorities in fast-paced settings without losing sight of quality or service standards

Collaborative Leadership: Skilled in influencing across matrixed teams, fostering alignment, and building consensus in complex organizational structures

Data-Driven Decision Making: Leverages analytics to identify trends, monitor KPIs, and implement targeted improvements that enhance both experience and efficiency

Talent Development: Demonstrated ability to lead, develop, and retain high-performing individuals and leadership teams in a performance-oriented culture