Director, Member Services

You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.

Job Description:

At Sun Life, we look for optimistic people who want to make life brighter for our Clients. We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work. Every day, you’ll be empowered and challenged by working with dynamic colleagues to find new and innovative ways to make Sun Life the best benefits company in America. 

The opportunity: As the Director, Member Services for PinnacleCare you are responsible for advancing and leading a best-in-class Member Services function focused on guiding individuals and families in all matters related to their health to help them secure the best care and achieve optimal health outcomes. You will play a key role in supporting the profitable growth of the business and delivering on our commitment to provide timely, exceptional service for our members and clients.  

You will develop the playbooks, metrics, and operating processes necessary to support the best member experience, health outcomes, and enable members to benefit from the broad range of additional support offering provided by PinnacleCare and Sun Life. This position is accountable for planning, leading, staffing and organizing a staff of 60+ direct and indirect team members.  

How you will contribute:

• Act as the voice of the customer for Comprehensive products and share feedback with product, sales, marketing and program teams to improve the overall member experience
• Provide guidance on best practices, including the development and implementation of policies and procedures to address member needs and create a best-in-class support function for members
• Define goals and KPIs for the Member Services team that are aligned to clear business outcomes and increase productivity/performance
• Direct team on the appropriate member service procedures, monitor service levels, and ensure compliance with member service procedures
• Ensure the organization’s operation is efficient, effective and in compliance with all federal, state, and country requirements
• Identify and implement strategic initiatives, enhancements for workflow & productivity, as well as, improved policies and procedures.
• Lead, manage, hire, train, retain and motivate employees capable of and committed to providing exceptional service to clients, customers and internal partners
• Coach, mentor, and provide ongoing development and performance management of direct and indirect reports
• Develop and foster excellent relationships with clients, members, and internal/external partners
• Ensure client, customer and other complaints/issues are addressed promptly and in accordance with service standards
• Utilize operational metrics and reports to track trends and results and adjusts tactics accordingly
• Develop, support and execute IT and strategic business initiatives and roadmap
• Direct and provide guidance and technical expertise to respective organization and clients ensuring objectives are met and maximize results in profitability

What you will bring with you:

• Ability to work with a diverse range of people
• 5+ years leadership experience directing a medium to large size organization required
• 10 years in healthcare or insurance services 
• Stop Loss, Payor, Clinical, or Insurance industry experience preferred
• Bachelors Degree required
• Extensive experience building and leading member facing support teams in a fast-paced, high-growth healthcare environment
• Proven experience managing complicated escalations and setting up effective SOPs designed to scale
• Empathetic and passionate about creating positive experiences in member and team interactions, with an ability to inspire and empower employees and develop high performing teams
• Experience or qualifications in Lean methodology
• Experience in process / workflow building, operational improvement, and project management
• Experience working with product and data teams to create and improve processes
• Ability to build models to answer your own questions to form data-driven, concrete answers in a world with imperfect information
• Excellent critical thinking, problem solving, analytical, and d