We are seeking an experienced Director of Customer Care Operations to lead and scale customer service operations within a dynamic healthcare technology environment. In this senior leadership role, you will oversee a large, multi-layered organization of approximately 150–200 pharmacy technicians and customer service agents, driving operational excellence, service quality, and an exceptional member experience. You will establish performance targets, optimize workflows, manage operational budgets, and use data-driven insights to improve efficiency and service outcomes. Working closely with Workforce Management, Quality Assurance, Training, Compliance, Legal, and executive leadership, you will translate business priorities and regulatory requirements into practical operational strategies. You will also lead continuous improvement initiatives, strengthen knowledge management, and identify opportunities to leverage technology and automation. This is an opportunity to shape scalable customer care operations while supporting a more transparent, efficient, and accessible healthcare benefits experience for millions of Americans.
Lead customer care operations: Oversee day-to-day operations through two Customer Care Managers and 12 Supervisors, with leadership accountability for approximately 150–200 pharmacy technicians and customer service agents supporting members, pharmacies, and clients.
Drive operational performance: Establish service level, quality, efficiency, and member experience targets, monitor performance against goals, and hold leaders accountable for measurable operational results.
Use data to improve outcomes: Analyze call trends, escalations, quality results, and operational metrics to identify root causes, prioritize improvement opportunities, and implement sustainable solutions.
Manage workforce planning and operational budgets: Partner with Workforce Management and Operations leadership to forecast demand, optimize staffing and scheduling, plan capacity, and manage labor costs against budget and forecast.
Deliver executive-level reporting: Prepare and present operational dashboards, performance insights, and business cases that support decisions about staffing, investment, resource allocation, and operating models.
Optimize workflows and processes: Lead initiatives to reduce operational friction, eliminate unnecessary rework, improve first-contact resolution, and increase productivity across customer care functions.
Maintain operational documentation: Oversee process documentation, job aids, workflow guidance, and knowledge management resources to ensure frontline teams have accurate, accessible, and consistent information.
Lead escalations and issue resolution: Coordinate the investigation of complex service issues, identify underlying causes, align stakeholders, and ensure corrective actions address problems sustainably.
Leverage technology and automation: Identify opportunities to improve service delivery through Salesforce CRM, Salesforce Knowledge, phone systems, the Member Portal, and other relevant technologies.
Partner on policy and regulatory compliance: Collaborate with Policy, Compliance, and Legal teams to translate regulatory and legislative requirements into practical procedures, ensuring customer care operations remain aligned with applicable obligations.
Strengthen quality assurance: Work with Quality Assurance and Compliance leaders to align quality standards and call evaluation criteria with operational priorities, using results to improve coaching, scorecards, and team performance.
Support training and development: Partner with Training leaders to identify knowledge and skill gaps, shape training initiatives, and reinforce the adoption of new systems, processes, and service expectations.
Maintain audit readiness: Ensure operational processes and documentation are prepared for audits and regulatory reviews, coordinating with Compliance and Legal to resolve corrective actions within established timelines.
Develop managers and supervisors: Coach and mentor operational leaders, strengthen leadership capabilities, build succession depth, and foster a culture of accountability, engagement, and continuous improvement.
Enhance performance management: Maintain and refine agent scorecards, quality measures, and performance management practices that support consistent coaching and fair, data-driven evaluations.
Champion the frontline and member experience: Engage with frontline employees, review member feedback, and help teams understand changing service expectations, recurring issues, and process improvements.
Lead strategic operational initiatives: Sponsor major projects, including new client and program launches, transitions, and operating-model changes, ensuring customer care readiness, scalability, and a positive frontline experience.
Represent Customer Care across the organization: Partner with executive leadership, clients, and cross-functional teams to align operational priorities with broader business goals and contribute to strategic initiatives.