Director of Customer Service

GENERAL SUMMARY:

The Director of Customer Service provides strategic and operational leadership for DWIHNs 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.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Strategic and Operational Leadership

Develop, implement, and evaluate DWIHNs 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. 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 service improvements and operational decision-making. Excellent communication, leadership, and conflict resolution skills. Other Duties as assigned.

Key Focus Areas

Customer Focus: Demonstrates empathy, responsiveness, and commitment to member-centered care. Regulatory Knowledge: Deep understanding of Medicaid and PIHP compliance requirements. Leadership: Inspires teams through integrity, transparency, and accountability. Data-Driven Management: Uses analytics to monitor performance and guide decisions. Equity and Inclusion: Promotes culturally competent, accessible, and equitable service delivery.

(Performance Expectations)

Facilitate Customer Service Staff development Demonstrates loyalty and commitment to DWIHN, its mission, vision and values. Upholds Leadership and Customer Service Team principles and promotes same in Customer Service staff. Assures Customer Service staff is in compliance with DWIHN policies.

KNOWLEDGE, SKILLS AND ABILITIES:

Advanced knowledge and expertise in management, supervision, organizational, operational skills and policy development Strong leadership and management skills are needed to guide teams and oversee complex operations. Ensure compliance with federal, state, and local mental health regulations, and prepare reports on program performance. Ability to work effectively with other behavioral health staff, members, service providers, advocacy groups and recipients. Capacity to motivate others as individuals and as in groups; the ability to determine what subordinates need to perform objectives, classify those requirements and assist subordinates to become confident that they can achieve their objectives. Openness to the emerging workforce in community mental health, (i.e., people with lived experience, their family members, allies and fictive kin). Healthy respect for the needs and interests of the individuals who receive services. Proficiency in Microsoft Office, including Outlook, Word, PowerPoint, and Excel. Exhibits superior management skills that emphasize team building and strong leadership with the ability to provide clear direction to the department. Proficient skill in oral and written communication Ability to exercise initiative, problem solving, leadership and decision making

DESIRED EXPERIENCE AND TRAINING:

Experience:

At least 5 years of expertise in managerial skills in a health care or public service environment. Training:

Masters degree from a recognized college and or university with a major in Health Service Administration, Organizational Management,

Business Administration Social Work, Public Health or other related areas.

WORKING CONDITIONS:

Work is usually performed in an office setting but requires the employees to drive to different sites throughout Wayne County and/or State.

The above statements are intended to describe the general nature and level of work being performed by person assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.