Senior Director, Service Operations

What you’ll doIn a few words…Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…Providing high quality services to clients and beneficiaries is at the core of what we do every day! The PBM Operations & Services team is the very heart of Abarca and meets that standard by running services from configurations, and beneficiary services to government services and beyond.As Senior Director, Service Operations you’ll be responsible for the strategic management and operations of all customer service support functions for pharmacies, physicians, and beneficiaries/members including but not limited to call center, fax queues, email, and web portal. You will work directly with the Rx Customer Service Managers and other PBM Operations areas to provide strategic direction, key quality monitoring programs, and operational support to ensure that all providers/members receive the highest quality of service in a short time frame, positively transforming their Healthcare. You will also oversee all fiscal aspects of the call center, and provider relations team oversight regarding complying with CMS related guidelines.The fundamentals for the job…Develop and communicate a clear vision for service operations aligned with the company’s overall strategy. This includes setting long-term goals, identifying emerging trends, and adapting the service model accordingly.Collaborate with key stakeholders, including executives, department heads, and external partners. Foster strong relationships to ensure seamless service delivery and alignment with organizational objectives.Identify potential risks and develop mitigation strategies. This includes addressing operational challenges, compliance issues, and any disruptions that may impact service delivery.Provide operational support to Customer Service Contact Center, and PBM Back Office teams to achieve efficiency and repeatability in the delivery of services.Establish clear benchmarks and best practices across all groups that have direct interactions with members, prescribers, pharmacies, or other healthcare service entities.Actively monitor, evaluate and drive integration of contact center technologies to enhance contact center operations.Analyze call center metrics to drive decision-making processes and to optimize resource allocation.Maintain and enhance the quality control program focused on the exchange of ideas and establish integrated goals aimed at caring for our members like family.Enhance and maintain a contact center culture that embraces empathy for our customers (i.e. Members, Pharmacists, Physicians and Clients).Collaborate seamlessly with the Talent Strategy team to embed the essence of Tribal Culture, leadership methodologies, and the core values of Abarca into every facet of member service.Oversee pharmacy/member customer service, ensuring compliance with all applicable laws, regulations, client contracts, policies, and procedures.Supervise and manage fulfillment of vendors and other outsourced services (e.g. Call Center, IVR, Print/Mail).Develop and oversee an expanded member customer service experience; identify leading industry practices and promote contact center culture that embraces empathy for our customers (i.e. Members, Pharmacists, Physicians and Clients).Manage the Rx Customer Service team as well as manage, budget, analyze monetary / fiscal responsibilities for the Service Operations cost center.Maintain a standard of continuous process improvement, which includes setting up the necessary control mechanisms for issue escalation.Participate in Issue Management, Quality Management, Change Advisory Board meetings, amongst others to ensure proper steps are taken to mitigate any member impact related to new/ongoing initiatives or issues.Ensure contact center metrics meet client expectations while complying with all federal CMS guidelines.Quickly resolve any issues that are necessary to ensure the Contact Center areas are fully compliant and fulfill all client contracts.Design and implement all relevant policies and procedures, while also working cross functionally with the Clinical and Client & Network Strategy groups to ensure provider, client, and beneficiary satisfaction regarding Abarca’s Service OperationsWhat we expect of youThe bold requirements…Bachelor’s degree or master’s degree in business administration, Healthcare or an related area. (In lieu of a degree, equivalent relevant work experience may be considered.)10 years of experience in a leadership role in the PBM or Insurance industries.Experience with PBM Operations, Member Services, Fulfillment, Call Center, and Medicare Part D.Experience with process improvement and handling multiple complex projects at the same time.Excellent oral and written communication skills.We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only)Physical requirements…Must be able to access and navigate each department at the organization’s facilities.Sedentary work that primarily involves sitting/standing.At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify. Abarca Health LLC does not sponsor employment visas at this time.The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.