• JOB DESCRIPTION Job Summary

Provides support for call center quality and excellence through auditing activities including: monitoring and assessing customer interactions of support center representatives, documenting performance strengths and weaknesses, identifying immediate compliance issues, assisting in generating standard process measurement reporting, and developing quality guidelines and procedural manuals.

Essential Job Duties

• Facilitates call monitoring and assessment of call center representatives for both inbound and outbound calls for the member and provider support center.
• Participates in call calibration exercises and internal listening sessions.
• Assists quality leadership in providing standard weekly and monthly reporting within predetermined reporting parameters.
• Provides regular feedback to quality leadership regarding call trends or compliance issues that arise.
• Collaborates with quality leadership to continually define quality assurance guidelines.
• Ensures internal and external customer interactions are handled in compliance with established procedures and standards.
• Demonstrates subject matter expertise in all business segments that require auditing (Medicaid, Medicare, Marketplace).
• Offers suggestions for process improvement and exceptional customer experience.
• Assists with the creation and updating of support center procedure/training manuals.
• Maintains overall objectivity in supporting consistent and superior customer service.

Experience coaching and developing employees, including providing 1:1 performance feedback related to quality, customer experience, and performance improvement. Previous coaching experience in a Quality, Lead, Trainer, or Supervisory capacity is preferred.

Provides inbound phone support as needed based on business and operational needs. Team members may be required to assist with call handling on designated days or during periods of increased call volume.

Required Qualifications

• At least 2 years of progressive work experience in quality assurance/auditing, call center, and/or customer service experience in a fast-paced/high-volume environment, or equivalent combination of relevant education and experience.
• Understanding of insurance products including Medicaid, Medicare and Marketplace/enrollment processes.
• Customer service skills, including ability to conduct thorough research while maintaining coherent conversation with customers.

• Data processing experience.

• Attention to detail, organizational and time-management skills, and ability to manage simultaneous tasks to meet business needs. • Ability to maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA). • Ability to establish and maintain positive and effective work relationships with coworkers, members, providers and customers. • Effective verbal and written communication skills. • Proficiency in Microsoft Office suite and applicable software programs.