Summary of Position

Promote quality achievement and performance improvement throughout the organization.
Frequently interface with and direct quality management counterparts or vendors to continuously improve performance for
claims, customer service, provider service, enrollment and billing, and medical and pharmacy core processes; and to achieve
end-to-end results across the EmblemHealth value stream.
Implement statistical process control on critical quality metrics by overseeing various initiatives to improve our member
experience in alignment with the mission and vision of our companies.

Principal Accountabilities

Lead a team of Quality Analysts that assess, evaluate, and implement scalable and efficient process redesigns that
improve member experience and align to operational metrics.
Work to update and develop complex processes; coordinate end to end solutions with internal stakeholders.
Direct and manage vendor quality operations by conducting capability analyses, transactional audits, quality program
verifications, compliance reviews and customer experience surveys.
Engage and lead daily or weekly huddles, transactional reviews, corrective action drilldowns and call calibrations with
quality counterparts
Drive transformational quality initiatives through growth development, and application of systemic Problem Solving
and Process Improvement.
Develop and maintain appropriate relationships with all stakeholders to facilitate the successful accomplishment of
key quality initiatives.
Mentor and lead team members to review, analyze and report statistical findings through critical thought and clear
and concise reporting of key findings and opportunities to all levels within the organization.
Acquire an understanding of current state process, analyze processes, data and systems- identify improvement
opportunities and make recommendations based on audit results.
Partner with Operations stakeholders to share data analysis, future state process, re-designs and quantified process
improvement implementation recommendations.

Education, Training, Licenses, Certifications

Bachelors' Degree, preferably in Healthcare, Business, or related quantitative field of study.

Relevant Work Experience, Knowledge, Skills, and Abilities

5 - 8+ years of relevant, professional work experience required
Experience in Quality Management and Improvement, Change Management, and Customer Experience required
Additional experience/specialized training may be considered in lieu of educational requirements required
Energy, drive and passion for End-to-End excellence and customer experience improvement required
Excellent collaboration skills and the ability to influence management decisions required
Strong problem solving and analytical skills that can be applied across all types of business problems required
Strong facilitation, verbal and written communication and presentation skills required
Solid coaching and mentoring skills to continuously develop staff core competencies at vendors required
Demonstrated Customer Experience focus and 1 year of process improvement experience required

Additional Information

• Requisition ID: 1000000589