Lead Director, Quality

The Lead Director is responsible for leading and optimizing Quality Operations, including all internal resources and outsourced support. This role will administer the strategy for monitoring and improving operational functions aligning policies and procedures with organizational objectives. Controls performance management and contributes to top-level decision making for the Customer Facing Operations Organization. This individual will develop and implement a comprehensive Quality roadmap to enhance client satisfaction, drive operational efficiency, and foster continuous improvement. The ideal candidate will be a strategic leader with a deep understanding of Quality best practices, technology solutions, and outsourcing partnerships.

Key Responsibilities:

• Develops and implements a comprehensive quality strategy aligned with the organization's overall objectives by defining quality goals, performance targets, and key performance indicators (KPIs).
• Leads continuous improvement initiatives to enhance quality management processes, increase efficiency, and reduce defects across the organization.
• Collaborates with various departments, such as Core Operations - Claims, Plan Build, Eligibility, Appeals, Compliance and Client Management, to ensure quality considerations are integrated into all aspects of the organization's operations.
• Establishes and maintains a robust quality management system by developing quality policies, procedures, and guidelines that comply with industry standards and regulatory requirements.
• Identifies potential quality-related risks and develops risk mitigation strategies to ensure the organization's products or services meet established quality standards.
• Analyzes quality data and generates regular reports on KPIs and quality metrics using data-driven insights to communicate quality performance to senior management.
• Ensures that quality initiatives and projects align with customer needs and requirements to enhance customer satisfaction.
• Manages the budget and allocates resources effectively to support quality improvement efforts.
• Provides leadership and guidance to quality management teams, overseeing their work, conducting performance evaluations, and providing training and development opportunities.
• Responsible for bringing forward new technology and service processes that will result in improved member and provider experiences, while also driving efficiencies in the customer service organization.
• Manage and optimize relationships with outsourcing partners to ensure performance, cost-effectiveness, and seamless integration with internal operations.
• Implement and leverage technology solutions, such AI chatbots and other automation tools, to enhance service capabilities.
• Sets strategic direction and influencing change that resulted in quantifiable positive outcomes.
• Ensures regulatory compliance.
• Collaborate with cross-functional teams, including Client Management, Local Market Development, IT and others to drive a customer-centric culture and improve service touchpoints. Develops and maintains strong collaborative relationships maintain excellent lines of communication and share resources to meet common service center objectives.
• Develop and implement training programs to ensure teams are equipped with the skills and knowledge to provide exceptional support.
• Stay informed of industry trends, customer expectations, and emerging technologies to maintain a competitive edge.

• 5+ years' experience in managing high volume transaction processing, financial management, project delivery, production, systems analysis and application.
• 5 + years' Quality or Work Process Auditing with a proven track record of developing and executing strategies that improve satisfaction and operational efficiency.
• 5 + years' management and leadership experience.
• 3 + years' experience managing outsourced service providers, ensuring contractual and performance expectations are met.
• Adept at execution and delivery (planning, delivering, and supporting) skills
• Certified Manager of Quality / Organizational Excellence (CMQ/OE) preferred.

• Adept at business intelligence
• Mastery of problem solving and decision-making skills
• Mastery of growth mindset (agility and developing yourself and others) skills

• Bachelor's degree in a closely related field, or equivalent combination of education and experience.