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Senior Director, Client Resolution and Quality Assurance – Customer Care

Remote

About Capital Rx 

Capital Rx is a health technology company providing claim administration and technology solutions for carriers, health plans, TPAs, employer groups, and government entities. As a public benefit corporation, Capital Rx is executing its mission to materially reduce healthcare costs as a full-service PBM and through the deployment of Judi®, the company’s cloud-native enterprise health platform. Judi connects every aspect of the healthcare ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of benefits and rebuilding trust in healthcare.

About the Role 

The Senior Director, Client Resolution and Quality Assurance, is a strategic leader responsible for overseeing the development, execution, and continuous improvement of Capital Rx’s client and member resolution operations within the Customer Care organization. This role will lead a high-performing team focused on delivering exceptional service to clients and members, while also establishing and maintaining a robust Quality Assurance (QA) program to ensure service excellence, compliance, and operational efficiency.  This individual will collaborate cross-functionally with internal stakeholders to align service delivery with organizational goals and client expectations, while driving a culture of accountability, continuous improvement, and customer-centricity. 

Key Responsibilities 

Client & Member Resolution Leadership 

  • Lead the Client Resolution team to ensure timely, accurate, and empathetic resolution of client and member inquiries and escalations. 
  • Develop and implement scalable support models and workflows that align with service level agreements (SLAs), regulatory requirements, and client expectations. 
  • Partner with Account Services, Implementations, and other internal teams to ensure seamless client onboarding and ongoing support. 
  • Monitor and analyze performance metrics to identify trends, root causes, and opportunities for improvement. 
  • Drive operational excellence through process optimization, training, and performance management. 
  • Serve as a senior escalation point for complex or high-impact client issues, ensuring swift and effective resolution. 

Quality Assurance Program Oversight 

  • Design, implement, and manage a comprehensive Quality Assurance program for the Customer Care organization. 
  • Establish QA standards, scorecards, and evaluation criteria to assess call quality, compliance, and customer experience. 
  • Lead a team of QA analysts to monitor interactions, identify coaching opportunities, and ensure adherence to policies and procedures. 
  • Collaborate with Training and Operations teams to develop targeted coaching and training programs based on QA findings. 
  • Provide regular reporting and insights to senior leadership on QA trends, risks, and improvement initiatives. 
  • Ensure compliance with HIPAA, regulatory, and internal standards through rigorous QA practices. 
  • Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance. 

Strategic Leadership & Cross-Functional Collaboration 

  • Contribute to the strategic direction of the Customer Care organization as a member of the leadership team. 
  • Lead and manage complex projects and initiatives that enhance service delivery and operational performance. 
  • Partner with Workforce Management to ensure appropriate staffing, forecasting, and contingency planning. 
  • Foster a culture of continuous improvement, innovation, and employee engagement. 

Qualifications 

  • A Bachelor’s degree in business management, or equivalent training and experience may be substituted and considered. 
  • 8+ years of progressive leadership experience in a call center or customer service environment, preferably in healthcare or PBM. 
  • 5+ years of experience managing client-facing teams and resolving complex client issues. 
  • 3+ years of experience leading Quality Assurance programs in a call center setting. 
  • Strong knowledge of call center technologies, including telephony platforms such as Five9, Content Guru, AWS Connect, or TalkDesk. 
  • Familiarity with Claims Adjudication systems and CRM platforms such as Salesforce (Health Cloud / Service Cloud). 
  • Proven ability to lead cross-functional teams and drive large-scale initiatives. 
  • Exceptional analytical, problem-solving, and communication skills. 
  • Demonstrated ability to manage multiple priorities in a fast-paced, dynamic environment. 
  • Project management certification or equivalent experience preferred. 

 

This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

 

Salary Range

$145,000 - $170,000 USD

This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. 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. 

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