Director of Member Services Operations

1 month ago


San Diego, California, United States Kaiser Permanente Full time
Job Summary:

As a key leader in Kaiser Permanente, the Director of Operations for Member Services will provide strategic direction and support to the Local Member Services professional staff across multiple sites. This role is responsible for overseeing daily operations, initiatives, and case processing, ensuring high-quality service delivery to both internal and external customers.

The ideal candidate will have a strong background in healthcare, with experience in customer service improvement, process redesign, and regulatory compliance. They will be able to drive business results, manage budgets, and foster a service-oriented work environment.

Key Responsibilities:
  1. Provide leadership and oversight to member services teams, ensuring effective management of daily operations and initiatives.
  2. Develop and implement strategies to improve member satisfaction, growth, and retention, working closely with regional and local leaders.
  3. Act as a liaison with medical groups, developing programs and service improvements to enhance the member experience.
  4. Manage high-risk issues, ensuring timely communication with medical facilities and stakeholders.
  5. Oversee the daily operations of the member services department, including auditing, training, and analyst work.
  6. Identify and mitigate member-system conflicts, minimizing financial penalties and promoting satisfied members.
  7. Lead, coach, and develop staff who handle sensitive and complex member issues and requests.
  8. Create a team atmosphere that promotes self-directed work, empowering staff to take ownership of their roles.
  9. Orient and educate facility departments, physicians, and staff on health plan products, benefits, and regulatory guidelines.
  10. Foster a service-oriented work environment, emphasizing dedication to serving members, respect for individuals, and achievement of high standards of quality.
Requirements:
  • Minimum 8 years of management/leadership experience in a complex healthcare or service-oriented organization.
  • Minimum 3 years of experience in customer service improvement and process redesign, with a focus on cultural sensitivity and polite communication.
  • Minimum 3 years of experience working with accreditation and regulatory agencies, including DHS, DMHC, NCQA, and CMS.
  • Bachelor's degree in Health Care Administration, Business Management, Science, or Business, or 4 years of experience in a directly related field.
  • High School Diploma or General Education Development (GED) required.
Preferred Qualifications:
  • Master's degree preferred.
  • Excellent investigation, problem-solving, and documentation skills.


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