Director, Customer Care Operations

Accountabilities

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.
Requirements
Education: Bachelor's degree in business, healthcare administration, or a related field, or an equivalent combination of education and professional experience.
Extensive customer care leadership: At least 10 years of experience in call center or customer care operations, including seven or more years in leadership roles managing managers, multiple teams, or large operational organizations.
Proven operational results: Demonstrated success improving service levels, quality, productivity, operational efficiency, and customer or member satisfaction through data-driven decision-making and process improvement.
Cross-functional collaboration: Experience partnering with Quality Assurance, Training, Compliance, and Policy teams to translate business, regulatory, and service requirements into effective operational practices.
People leadership and coaching: A strong track record of developing managers and supervisors, improving team performance, strengthening leadership capabilities, and building effective knowledge management practices.
Analytical and business acumen: Strong analytical skills, with the ability to interpret operational data, identify trends, evaluate performance, and translate findings into actionable recommendations for senior leadership.
Workforce management knowledge: An understanding of forecasting, staffing, scheduling, and capacity planning, with the ability to align resources with service demand and operational objectives.
Process improvement expertise: Experience identifying inefficiencies, redesigning workflows, managing operational change, and implementing scalable solutions that improve service delivery.
Technology proficiency: Proficiency with Microsoft 365 applications, including Outlook, Word, Excel, and PowerPoint, and familiarity with customer care systems and operational technology.
Communication and stakeholder management: Excellent written and verbal communication, interpersonal, problem-solving, and conflict-resolution skills, with the ability to influence stakeholders across organizational levels.
Customer-centric mindset: A strong commitment to member satisfaction and service recovery, including the ability to transform challenging customer interactions into positive experiences.
Project and priority management: The ability to lead multiple projects simultaneously, meet deadlines, manage competing priorities, and maintain execution quality in a fast-paced environment.
Integrity and accountability: Demonstrated professional integrity, sound judgment, and a commitment to ethical conduct, regulatory compliance, and responsible decision-making.
Preferred qualifications:
Experience in pharmacy operations, pharmacy benefits management, or health insurance operations.
Familiarity with process improvement, quality management, and project management methodologies such as Lean, Six Sigma, or PMP-based practices.
Hands-on experience with workforce management systems, forecasting models, and capacity planning.
Proficiency with Salesforce CRM, Salesforce Knowledge, contact center phone systems, and member-facing portals.
Knowledge of HIPAA and other healthcare regulatory requirements relevant to customer care operations.
Spanish language proficiency, particularly in environments serving diverse member populations.
A strong ability to build collaborative working relationships across business, technical, and operational teams.
Benefits
Competitive compensation: Annual base salary ranging from $135,200 to $213,500, depending on experience, knowledge, skills, and work location.
Remote work flexibility: A fully remote opportunity for candidates based in the United States.
Leadership and professional development: The opportunity to lead a large customer care organization, develop future leaders, and shape scalable operational practices.
Strategic business impact: The ability to influence service quality, operational efficiency, and the healthcare benefits experience for members, pharmacies, and clients.
Technology-driven environment: Opportunities to improve customer care through modern platforms, knowledge management systems, process automation, and operational analytics.
Cross-functional collaboration: Work closely with executive leadership and teams across Operations, Workforce Management, Quality Assurance, Training, Compliance, Policy, and Legal.
Continuous improvement culture: Lead meaningful initiatives that strengthen service delivery, improve employee effectiveness, and support sustainable business growth.
Equal opportunity workplace: Join an organization committed to providing equal employment opportunities and maintaining a professional environment free from discrimination and harassment.