AVP, Member Experience
Apply NowCompany: EmblemHealth
Location: New York, NY 10025
Description:
Summary of Position
Lead the enterprise definition, communication, implementation and maintenance of stakeholder experiences and journeys
(focused on Member and Provider). Partner with various functional and P&L leadership to define/refine and measure
outcomes of experience and journeys.
Accountable for identifying and executing, in partnership with our Technology team, new technical capabilities, strategies
and potential uses of artificial intelligence capabilities that improve our member experience and quality outcomes
Collaborate with experience quality, training, knowledge management and customer service teams to ensure adoption and
expertise of staff participating in / driving experiences and journeys.
Manage to administrative financial targets.
Design and deliver integration with programs including Neighborhood Care, EmblemHealth Solutions at ACPNY/ACPNY Express and Patient Advocate Program (HUB).
Principal Accountabilities
Experience Definition and Implementation:
Define and deliver Member/Stakeholder Experiences, Journeys including digital, print, and voice channels of static
information, transaction experience and dynamic journeys. Responsible for assessing current state vs future state
experience and defining an achievable project path to implementation and ongoing optimization.
Develop a member experience roadmap with short term wins, introduction of new capabilities and technology tools;
execute new quality/training/hiring practices with data driven rigor.
Journey Definition and Implementation:
Architect integrated positive journeys using Member engagement platforms (Call - Genesys, CRM SF
Service/Mktg/CDP/Exp Cloud) along with experience tools, including Adobe Experience Manager (AEM), Salesforce
(Marketing Cloud, Experience Cloud (portals), Service Cloud/Health Cloud, and Consumer Data Platform
segmentation engine.
Act as product owner for development planning and feature functionality.
Develop and recommend tele-sales strategy, providing options for consideration leveraging staff augmentation vs a
fully insourced model. Implement and drive for positive results.
Health Payer /Quality CAHPS:
Responsible for partnering with the Clinical leadership team to achieve health payer operations including member
satisfaction, retention, and clinical/non-clinical engagement as well as Medicare Stars/Quality/CAHPS metrics.
Drive performance to exceed industry standards as measured by Net Promoter Score, CAHPs and STARs ratings.
Project Management:
Render the complex simple by breaking into deliverable pieces and creating incremental value toward final state;
PMO, Communication and coordination.
Responsible to architect integrated positive experiences and journeys then successfully implement using noted tools,
personnel (call center staff, outreach staff, etc.) and physical/retail assets.
Develop cost containment/value retention strategies related to stakeholder experience.
Community based outreach/resource exposure and knowledge:
Create higher engagement levels, completions of journeys as well as higher NPS and continuous engagement /brand
affinity through an understanding of community resources and their role in urban and suburban populations.
Leverage community resources like EmblemHealth Neighborhood Care and Advantage Care Physicians of NY.
Define and lead retail Community based staff to deliver on KPIs outlined for that resource.
Collaboration and Cooperation:
Drive accountability across stakeholders and lead by collaborative example by building relationships, marshalling resources,
communicating barriers and collaborating to deliver on execution and implementation scope, outcomes and timeliness
Education, Training, Licenses, Certifications
Bachelor's degree in clinical specialty, healthcare, business, or other related area; Master's degree in healthcare or business preferred.
Relevant Work Experience, Knowledge, Skills, and Abilities
12 - 15+ years' related experience in positions of increasing responsibility/complexity, including stakeholder experience.
5 - 10+ years' managed healthcare experience.
Experience articulating a vision, garnering business buy-in, carrying out corporate-wide projects, delegating responsibility,
and holding teams (and oneself) accountable for results.
Experience managing a diverse and distributed team; ability to manage multiple locations and remote staff.
Experience in the development and implementation of metrics and analytics to measure performance.
Ability to interpret & implement federal, state and local guidelines for all aspects of the member and provider processes.
Proven ability in the development and implementation of metrics and analytics to measure performance.
Proven experience in cost containment for a large division, department, or company.
Excellent communication skills (verbal and written) with a proven track record of effectively interfacing, training, presenting
information to multiple levels of the organization.
Proficient in MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.).
Ability to work successfully with key stakeholders.
Understanding of industry regulatory environment and experience working with regulators at the state and federal levels.
Subject matter expert in insurance operations including enrollment and billing, customer service, medical management, and
claims processing.
Previous experience with Genesys, CRM SF Service/Mktg/CDP/Exp Cloud
Previous experience with Adobe Experience Manager (AEM), Salesforce (Marketing Cloud, Experience Cloud (portals), Service Cloud/Health Cloud, and Consumer Data Platform segmentation engine.
Lead the enterprise definition, communication, implementation and maintenance of stakeholder experiences and journeys
(focused on Member and Provider). Partner with various functional and P&L leadership to define/refine and measure
outcomes of experience and journeys.
Accountable for identifying and executing, in partnership with our Technology team, new technical capabilities, strategies
and potential uses of artificial intelligence capabilities that improve our member experience and quality outcomes
Collaborate with experience quality, training, knowledge management and customer service teams to ensure adoption and
expertise of staff participating in / driving experiences and journeys.
Manage to administrative financial targets.
Design and deliver integration with programs including Neighborhood Care, EmblemHealth Solutions at ACPNY/ACPNY Express and Patient Advocate Program (HUB).
Principal Accountabilities
Experience Definition and Implementation:
Define and deliver Member/Stakeholder Experiences, Journeys including digital, print, and voice channels of static
information, transaction experience and dynamic journeys. Responsible for assessing current state vs future state
experience and defining an achievable project path to implementation and ongoing optimization.
Develop a member experience roadmap with short term wins, introduction of new capabilities and technology tools;
execute new quality/training/hiring practices with data driven rigor.
Journey Definition and Implementation:
Architect integrated positive journeys using Member engagement platforms (Call - Genesys, CRM SF
Service/Mktg/CDP/Exp Cloud) along with experience tools, including Adobe Experience Manager (AEM), Salesforce
(Marketing Cloud, Experience Cloud (portals), Service Cloud/Health Cloud, and Consumer Data Platform
segmentation engine.
Act as product owner for development planning and feature functionality.
Develop and recommend tele-sales strategy, providing options for consideration leveraging staff augmentation vs a
fully insourced model. Implement and drive for positive results.
Health Payer /Quality CAHPS:
Responsible for partnering with the Clinical leadership team to achieve health payer operations including member
satisfaction, retention, and clinical/non-clinical engagement as well as Medicare Stars/Quality/CAHPS metrics.
Drive performance to exceed industry standards as measured by Net Promoter Score, CAHPs and STARs ratings.
Project Management:
Render the complex simple by breaking into deliverable pieces and creating incremental value toward final state;
PMO, Communication and coordination.
Responsible to architect integrated positive experiences and journeys then successfully implement using noted tools,
personnel (call center staff, outreach staff, etc.) and physical/retail assets.
Develop cost containment/value retention strategies related to stakeholder experience.
Community based outreach/resource exposure and knowledge:
Create higher engagement levels, completions of journeys as well as higher NPS and continuous engagement /brand
affinity through an understanding of community resources and their role in urban and suburban populations.
Leverage community resources like EmblemHealth Neighborhood Care and Advantage Care Physicians of NY.
Define and lead retail Community based staff to deliver on KPIs outlined for that resource.
Collaboration and Cooperation:
Drive accountability across stakeholders and lead by collaborative example by building relationships, marshalling resources,
communicating barriers and collaborating to deliver on execution and implementation scope, outcomes and timeliness
Education, Training, Licenses, Certifications
Bachelor's degree in clinical specialty, healthcare, business, or other related area; Master's degree in healthcare or business preferred.
Relevant Work Experience, Knowledge, Skills, and Abilities
12 - 15+ years' related experience in positions of increasing responsibility/complexity, including stakeholder experience.
5 - 10+ years' managed healthcare experience.
Experience articulating a vision, garnering business buy-in, carrying out corporate-wide projects, delegating responsibility,
and holding teams (and oneself) accountable for results.
Experience managing a diverse and distributed team; ability to manage multiple locations and remote staff.
Experience in the development and implementation of metrics and analytics to measure performance.
Ability to interpret & implement federal, state and local guidelines for all aspects of the member and provider processes.
Proven ability in the development and implementation of metrics and analytics to measure performance.
Proven experience in cost containment for a large division, department, or company.
Excellent communication skills (verbal and written) with a proven track record of effectively interfacing, training, presenting
information to multiple levels of the organization.
Proficient in MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.).
Ability to work successfully with key stakeholders.
Understanding of industry regulatory environment and experience working with regulators at the state and federal levels.
Subject matter expert in insurance operations including enrollment and billing, customer service, medical management, and
claims processing.
Previous experience with Genesys, CRM SF Service/Mktg/CDP/Exp Cloud
Previous experience with Adobe Experience Manager (AEM), Salesforce (Marketing Cloud, Experience Cloud (portals), Service Cloud/Health Cloud, and Consumer Data Platform segmentation engine.