Job description
At Clover Health, we bring high-quality, affordable, and easy-to-understand healthcare plans to America’s seniors. We focus on preventive care and leverage data and technology from the Clover Assistant to empower physicians to make the best health recommendations based on our members’ complete health history—all with the lowest cost and the highest value.
As the Director of Customer Experience, you will lead the execution of the customer engagement strategy and the delivery of an exceptional experience for our Medicare Advantage members and providers. Partnering with the VP of Customer Experience, you will help drive a customer-centric culture organization, oversee all in-house and 3rd party Service Center Operations, collect and analyze the voice of the customer and establish a feedback loop to the business leadership team and Customer Experience key stakeholders. You will also be responsible for standing up a concierge call center for high-engagement and/or at-risk members. An important aspect of this role includes leveraging AI capabilities to enhance customer experience initiatives. You will analyze data and insights from AI tools to optimize call center operations, increase customer self-service, monitor call quality, and conduct sentiment analysis.
Responsibilities:
Strategy and Leadership:
- Partner with the VP of Cx to drive a Cx-centered culture.
- Provide input to help define a winning Cx strategy, focusing on Medicare Advantage members and providers.
- Lead the execution of the customer engagement strategy for the Medicare Advantage business.
- Stand up and manage a concierge call center for VIP and at-risk members.
- Provide requirements into the overall CRM roadmap.
- Identify and implement AI-driven solutions to enhance customer experience, such as leveraging AI for call center agents, customer self-service solutions, call quality monitoring, and sentiment analysis.
- Leverage AI to collect and analyze the voice of the customer, as reflected throughout the Service Center interactions.
- Provide input and requirements into the Cx Customer Data Platform and Digital Journey, including the integration of AI capabilities.
- Establish an integrated and holistic feedback loop of the Voice of the Customer to the business.
Operational Oversight:
- Be accountable for understanding the direction of the company and its associated service needs.
- Work cross-functionally with peers in Sales, Marketing, Provider Engagement, Clinical Operations, Claims, Enrollment, etc. to coordinate and grow together, and cascade down to your team for a clear direction.
- Oversee and optimize third-party call centers, both stateside and offshore, handling member and provider services.
- Oversee offline case inventory, such as secure messaging, email, case escalations, voicemail, and chat, for both members and providers.
- Oversee a third-party outbound team focused on member retention and growth, including demand and capacity planning, outbound lead generation, reporting, data loading, training, scripting, and performance.
- Oversee an internal Quality Assurance team, focused on trend identification, process improvement, and strategic alignment across the enterprise.
- Own the development and maintenance of all Standard Operating Procedures relating to member, provider, and broker experience, including training materials and DLP repositories.
- Oversee vendor relationships for multiple supplemental benefit vendors, including regular touchpoints, reporting, call calibration sessions, performance management, invoice validation, RFP participation, and overall strategy.
- Oversee and be accountable for the performance of assigned vendors, including but not limited to Service Levels, ASA, NPS, FCR, Handle Time, and Post Call Surveys.
- Oversee and optimize workforce scheduling.
- Work with Clover’s Compliance Team to ensure regulatory compliance in our communications, research and respond to CTMs, and update monthly delegatory reporting.
- Work with IT operations and workforce management to develop, maintain, and improve IVR call flows, system enhancements, and data needs.
- Own the onboarding and system access acquisition for all Call Center vendor and internal employees.
- Develop, measure and track Cx Service Center goals and metrics and ensure they are being met.
- Manage communication activities, performance expectations and goals, evaluate processes and outcomes, and implement improvements to support quality and efficiency.
Success in this role:
By the end of your 90-day period, you will have:
- Seamlessly integrated into the Customer Experience team.
- Established strong working relationships with key stakeholders across Sales, Marketing, Provider Engagement, Clinical Operations, Claims, Enrollment, and IT.
- Developed a deep understanding of Clover’s existing customer engagement strategy, Service Center operations (in-house and 3rd party), and current voice of the customer feedback mechanisms.
- Assessed the current people, process, and technology, identifying gaps that need to be addressed.
- Actively contributed to the initial planning and foundational setup of the concierge call center.
By 6 months, you will have:
- Been fully immersed in the role, independently leading the execution of the customer engagement strategy for Medicare Advantage.
- Established and begun managing the concierge call center for high-engagement and/or at-risk members, demonstrating initial successes in member satisfaction and retention within this segment.
- Identified additional key opportunities for AI-driven enhancements in customer experience.
- Begun to implement initial solutions for call center operations, self-service, or sentiment analysis.
- Have established and started executing upon the formal feedback loop of the Voice of the Customer to the business leadership team and key stakeholders.
Future success in this role, you will be measured by your impact on:
- Overall Medicare Advantage member and provider satisfaction, retention, and the continuous improvement of the customer experience.
- Optimized Service Center operations (both in-house and 3rd party).
- Increased customer self-service through AI capabilities.
- Enhanced call quality and sentiment analysis.
- A robust and impactful feedback loop that drives business improvements.
- Achieving key measures of success such as member retention and CAHPS Measures - Health Plan Customer Service Questions.
You should get in touch if:
- You have 7+ years of call center experience (required).
- You have 7+ years of experience working in a Medicare Advantage environment (required).
- You have 7+ years of experience managing a team (required).
- You have a Bachelor’s degree in business, health administration, finance, or related field required; advanced degree (MBA, MHA, MPH) a plus.
- You have experience managing a third-party offshore call center (preferred).
- You have extensive knowledge of back-office health plan functions (Claims, Enrollment, Provider Services).
- You have a strong understanding of AI technologies and their application in customer experience, particularly within a call center environment.
- You have advanced proficiency in data analysis and spreadsheet software (e.g., Microsoft Excel, Google Sheets) with experience handling large datasets.
Benefits Overview:
- Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions.
- Physical Well-Being: We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare.
- Mental Well-Being: We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location.
- Professional Development: Developing internal talent is a priority for Clover. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews.
Additional Perks:
- Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
- Reimbursement for office setup expenses
- Monthly cell phone & internet stipend
- Remote-first culture, enabling collaboration with global teams
- Paid parental leave for all new parents
- And much more!
About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we’ve created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.
We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.
From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences, perspectives, opinions, and backgrounds, who share a passion for improving people’s lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone’s responsibility.
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Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.
For California, Colorado, New Jersey, New York, or Washington residents, a reasonable estimate of the base salary range for this role can be found below. For candidates residing in other geographic areas, the range will be adjusted based on location. Final pay is based on several factors including but not limited to internal equity, market data, and the applicant’s education, work experience, certifications, etc.
Colorado/Washington Pay Range
$136,000 - $180,000
California/New Jersey/New York Pay Range
$136,000 - $200,000
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