Quality Assurance Specialist / Job Req 637800780

Job title:

Quality Assurance Specialist / Job Req 637800780

Company

Alameda Alliance for Health

Job description

Job Description:

PRINCIPAL RESPONSIBILITIES:

Under the general guidance from the Quality Assurance and Regulatory Reporting Manager, the Quality Assurance Specialist is responsible for assessing the quality of service provided by Member Services staff by reviewing calls, call documentations, and written communications. The duties include work in the areas of user and systems requirements, support and analysis, documentation, applications support, and troubleshooting of call center applications.

Principal responsibilities include:

• Assess the quality of phone-based service through the review of recorded calls and actions taken (or not taken) by Member Services Representatives.
• Assess the quality of documentation created by Member Services staff through the review of call documentation including the quality of notes taken, appropriate referrals to others for help, and timely follow-up to ensure problem resolution.
• Assess the quality of web-based service through the review of requests received over the Member Portal, and the quality and timeliness of actions and responses related to those requests.
• Assess the quality of e-mail-based service through the review of requests received via email, and the quality and timeliness of actions and responses related to those requests.
• Collect quality findings in quality monitoring databases, and provide analyses and summaries as needed to other members of the Member Services leadership team.
• Conduct internal quality audits to ensure operations are in compliance with all regulations, standards, policies, and procedures. Prepare and submit audit reports to the Director.
• Collaborate with the Member Services leadership team to identify staff training and development needs for improved performance.
• Assist in the coaching of staff towards meeting and exceeding performance expectations for quantity, quality, timeliness and efficiency
• Support continuous improvement of call center effectiveness through the development, evaluation and refinement of policies and procedures that meet the operational and regulatory goals and requirements.
• Prepare standard and ad hoc reports.
• Perform other duties and special projects as assigned.

ESSENTIAL FUNCTIONS OF THE JOB

• Ensure quality audits are done in a timely manner and at an appropriate volume.
• Complete reports and communicate findings in an accurate and timely manner.
• Monitor call documentation system and ensure appropriate use.
• Collaborate with other Member Services staff to continuously improve departmental performance.
• Telephone usage and ongoing data entry.
• Participate in departmental and non-departmental meetings and other scenarios.
• Comply with the organization’s Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.

PHYSICAL REQUIREMENTS

• Constant and close visual work at desk or computer.
• Frequent sitting and working at desk.
• Frequent use of headset.
• Constant use of multiple screens.
• Constant data entry using keyboard and/or mouse.
• Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
• Frequent lifting of folders, files, and other objects weighing between 0 and 30 lbs.
• Frequent walking and standing.
• Occasional need to stand for one to two hours at a time to deliver training or presentations to large groups.

Number of Employees Supervised: 0

MINIMUM QUALIFICATIONS:

EDUCATION OR TRAINING EQUIVALENT TO:

• Two years of college required or combination of education and equivalent experience.
• High school diploma.
• The ability to speak, read and understand-bilingual: Spanish/English, Cantonese/English, Vietnamese/English and/or Tagalog/English preferred.

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

• Two years of experience assessing the performance of others and providing individual feedback required.
• Two years of experience in health services, managed care, hospital, or similar setting required.
• Two years of experience as Customer Service Representative (telephonic) preferred.
• 6 months – 1 year Medical Terminology preferred
• Experience with medical claims processing software (such as HealthSuite) highly preferred.
• Experience with call monitoring applications (such as Calabrio) highly preferred.
• Experience in categorizing and processing member grievances using regulatory guidelines preferred.

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

• Excellent oral and written communication skills.
• Excellent analytical and database management skills.
• Excellent listening and interpersonal skills.
• Excellent teaching and coaching skills.
• Leadership and team development skills.
• Ability to develop simple but effective reports.
• Ability to represent organization and department well.
• Strong customer focus.
• Strong business acumen.
• Proficient in use computer software programs including Microsoft Office suite, particularly Excel and Access.

SALARY RANGE $33.46 – $50.20 HOURLY

The Alliance is an equal opportunity employer and makes employment decisions on the basis of qualifications and merit. We strive to have the best qualified person in every job. Our policy prohibits unlawful discrimination based on race, color, creed, gender, religion, veteran status, marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition, genetic characteristic, sexual orientation, gender identity or expression, or any other consideration made unlawful by federal, state, or local laws. M/F/Vets/Disabled.

Expected salary

$33.46 – 50.2 per hour

Location

Alameda, CA

Job date

Sat, 17 Feb 2024 08:58:41 GMT

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