Director Of Customer Service

Director Of Customer Service

The Director of Customer Service provides strategic and operational leadership for DWIHN's Customer Service Department to ensure timely, compassionate, and effective support to members, providers, and stakeholders. This position ensures compliance with all applicable federal, state, and local regulations, including MDHHS Customer Service Standards, Medicaid Managed Care requirements, and PIHP contractual obligations. The Director drives continuous improvement in service quality, access to care, and member satisfaction across all lines of business, including behavioral health, substance use disorder, and integrated care coordination.

Strategic and Operational Leadership

• Develop, implement, and evaluate DWIHN's Customer Service strategy in alignment with organizational mission, values, and state requirements.
• Lead the design and delivery of a high-performing customer service model that supports members, families, and providers with timely information, problem resolution, and navigation support.
• Oversee Customer service call center operations, member inquiries, grievances, appeals, and customer satisfaction tracking.
• Ensure compliance with PIHP/MDHHS standards, Medicaid/Medicare guidelines, and applicable accreditation or regulatory bodies.
• Collaborate with departments such as Provider Network, Quality Improvement, Compliance, and Access to coordinate seamless member experiences.
• Monitor compliance with the MDHHS contract requirements, including response timeliness, documentation standards, and reporting metrics.
• Oversee the management of grievances and appeals, ensuring accurate tracking, analysis, and resolution within regulatory timelines.
• Utilize data analytics and customer feedback to identify service trends, gaps, and opportunities for improvement.
• Coordinate corrective action plans when service deficiencies or compliance issues are identified.
• Supervise and mentor Customer Service Managers, Supervisors, and staff to maintain a culture of accountability, empathy, and excellence.
• Implement ongoing training and professional development programs to ensure staff are equipped to support complex member needs, including behavioral health crisis and service navigation.
• Promote a trauma-informed, recovery-oriented, and culturally responsive approach in all customer interactions.
• Develop key performance indicators (KPIs) for the department and regularly report outcomes to executive leadership and the Board.
• Prepare and present reports to MDHHS, DWIHN leadership, and other stakeholders on customer service trends and member satisfaction.
• Lead service improvement initiatives, including the implementation of technology solutions, automation, and performance dashboards.
• Serve as a primary liaison with external partners, including provider agencies, community-based organizations, and advocacy groups, to address system-level service concerns.
• Represent DWIHN at community meetings, advisory councils, and public forums to promote transparency and responsiveness.
• Collaborate with internal departments and community partners to ensure smooth member transitions and coordination of care.
• Proven ability to use data analytics to inform