Where compassion meets innovation and technology and our employees are family.

GENERAL PURPOSE OF JOB:

The Quality Assurance Specialist is responsible for monitoring inbound/outbound healthcare calls for Member/Provider. Develop process improvements; analyze performance with the use of resources, and to identify

concerns for/by Member/Provider to ensure a first call resolution. The Quality Assurance Specialist will also assist the Customer Service Supervisor by providing direct coaching and feedback to the Customer Service

Representatives (CSRs).

ESSENTIAL DUTIES AND RESPONSIBILITIES:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or health plan administration, as required.

General Duties:

Screens incoming and outgoing calls to ensure quality, customer service, and adherence to the policies and procedures of the organization.

Complete designated number of documented monitors of customer contacts.

Utilize approved monitoring tools and standards to assess the representatives’ knowledge of products, business practices and systems.

Convert monitor findings and scores into coaching recommendations for performance improvement actions to internal/external parties.

Facilitate scheduled calibration sessions that foster a consistent and reliable assessment of representative’s skills and behaviors by internal/external parties.

Generate calibration recap reports for each scheduled calibration session.

Participate in user acceptance testing exercises as needed for new product releases.

Prepare reports as needed for the management team.

Participate as needed in conference calls and meetings.

Will be required to complete 4 hours of phone time monthly.

Exceptional listening, analytical, and communication skills (written and oral).

Researches and formulates solutions in conjunction with leadership related to call center representative performance.

Ability to identify issues, to obtain relevant information, relate and compare data from different sources, and identify alternative solutions.

Ability to accomplish tasks accurately and completely.

Ability to take action to achieve goals beyond what is required; ability to be proactive.

Ability to develop plans to accomplish tasks and objectives, work using resources efficiently, to follow instructions through a standard work process, and to monitor or regulate those procedures, tasks, or activities.

Perform other assigned duties as needed.

Training Responsibilities

Participate and support refresher training as needed on quality monitoring methods, tools, facilitation skills, and product features.

From call monitor data, identify opportunities to improve training content.

EDUCATION AND/OR EXPERIENCE:

• Minimum of a High School diploma; or a minimum of two year’s progressive experience in a call center or equivalent combination of education and experience.

• Outstanding communication skills and the ability to understand complex situations to effectively handle customer needs.

• Strong knowledge of Microsoft Office, including Word, Excel, PowerPoint and Outlook

• Knowledge of commonly-used concepts, practices, and procedures within the call center.