HealthPlanOne's mission is to help people find the right health insurance at the right price, so they live healthier lives. We are committed to making the shopping process simpler. Our mission has never been more important than it is today.
The Quality Assurance Lead will assist in training QA Specialists, audit scorecards, process appeals and create quality reports. The Quality Assurance Lead will serve as a subject matter expert for the QA Specialists.Supervisory Responsibilities: None
Duties/Responsibilities:
- Create training materials for agents, specialists, and ops leaders.
- Spot check/audit auditors: randomly audit the work product from the Quality Team.
- Create and distribute various client and Operations custom reports: Agent QA scores, appeals, other various quality & coaching reports.
- Participate in client and Account Management meetings to provide input from the Lead’s specific line-of-business.
- Meet with Operational Leaders to provide calibrations, reporting analysis and training sessions.
- Attends Operations Supervisor/Agent QA coaching sessions as required to provide additional detail and/or clarity where needed in follow up to the audit and the QA coaching request.
- Process appeals: Investigate, manually make changes, and document appeal findings.
- Work side-by-side with internal quality assurance platform developers assisting with debugging, testing, troubleshooting, suggesting process enhancements, etc.
- Assist with auditor training and alignment: /Ensure auditors stay aligned with material and systems, answering questions.
- Serve as the dedicated Subject Matter Expert per the line of business.
- Evaluates/audits calls and evaluate the quality of each call based on the quality guidelines and standards
- Score each call based on compliance criteria
- Resolve escalated issues with members, carriers and internal clients.
- Perform other related duties as assigned
Required Skills/Abilities:
- High school diploma or equivalent
- Excellent written and oral communication
- Ability to work under set production goals
- Accurate data recording
- Analytical, organized and detail oriented
- Excellent proofreading skills
- Knowledge of Excel and Outlook
- Knowledge of CMS
Preferred Skills/Abilities:
- Associate degree in business or related field
- Quality assurance analyst/evaluator experience or a current and valid Life, Health and Annuity License (215)
- Exposure to Medicare and other insurance products
- Bilingual speaking skills (English and Spanish)
Physical Requirements:
- Prolonged periods of sitting at a desk and working on a computer, typically in a cubicle environment (constant noise, fluorescent overhead lighting)
- Able to wear headset for duration of shift
Equal Employment Opportunity (EEO) is a fundamental principle at HealthPlanOne, where employment is based upon personal capabilities and qualifications. HealthPlanOne does not discriminate because of actual or perceived sex, sexual orientation or preference, gender identity, gender, transgender, race, color, religion, national origin, creed, citizenship status, ancestry, age, marital status, pregnancy, childbirth or related medical conditions, medical conditions including genetic characteristics, mental or physical disability, military and veteran status, or any other protected characteristic as established by law. HealthPlanOne requires the necessary drug testing and background checks as part of our pre-employment practices. If you need assistance or an accommodation due to a disability, please contact us to request accommodation at [email protected]
