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Director of Call Center Quality and Compliance

Job Ref: 65275
Category: Call Center
Department: CALL CENTER
Location: 1 Metrotech Center North, Brooklyn, NY 11201
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $120,000.00
Salary Range: $120,000.00 - $137,000.00

About NYC Health + Hospitals

MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. 

Position Overview

This position will serve as a central point of contact for quality needs to identify trends and improvement opportunities on an individual, team, and call center levels with the objective of improving customer satisfaction while meeting regulatory and compliance requirements. Working in collaboration with the customer service management team, this role is responsible for the oversight of the quality for call center including compliance, audits and training and knowledge management.

Job Description

  • Proactively identify, analyze, remediate, or modify operational processes that eliminate excess capacity, defects in workforce models and forecasts to deliver best in class workforce plans.
  • Serve as the subject matter expert for various project implementation teams.
  • Works with the Senior Director of Customer Service to develop/maintain department performance goals and objectives which is cascaded down to each individual team member as appropriate.
  • Partner with Learning and Organizational Development to ensure that new hire and ongoing training represents training and organizational best practices, and all contractual requirements are met.
  • Ensures the availability of a robust knowledge management system that has a comprehensive library of desk manuals that contains all plan information and processes; and maintains the knowledge management in accordance with contract ensuring that all CSRs utilize the system as a source of information.
  • Oversees the call center’s quality assurance and implements any necessary corrective actions to ensure consistent application of all laws, regulations, and policies.
  • Works directly with Compliance team to plan internal audits, prepare for external audits and plan readiness assessment by collecting and evaluating internal processes ensuring alignment with regulatory requirements.
  • Complete regular analysis (monthly and quarterly) of call center performance reports and ensure accuracy and timely distribution of reports that provide insight to performance.
  • Oversight of Call Center vendor performance and conduct monthly evaluations based on agreed upon SLAs.
  • Ensures MetroPlus Health’s Call Center follows and complies with all contract, state and regulatory agency guidelines and standards.
  • Develop and manage annual operations budget. Track invoices and expenditures ensuring careful evaluation of trends and expenses that impact budget.

Minimum Qualifications

  • Bachelor of Science in Healthcare, Business Administration degree or higher strongly preferred
  • Lean Six Sigma certification (Yellow, White or Green Belt) preferred OR demonstrated quality management and continous process improvement experience
  • Minimum 5-7 years of Call Center/Contact Center management experience in a health plan or managed care setting. 
  • Experience with call center systems (e.g. Avaya, Cisco, NICE, Verint, Salesforce, etc.)
  • Demonstrated experience with metrics and analysis including workforce planning, productivity, SLAs and KPIs required.
  • Proven ability to develop and manage budget.
  • Computer Skills: Advanced skills with suite of Microsoft products including Outlook,
  • Word,Visio, Power Point and Excel

Professional Competencies

  • Integrity and Trust
  • Charisma
  • Customer Focus
  • Functional/Technical skills
  • Excellent Written/Oral Communication
  • Strong People Management