Job Description

The Quality Assurance Specialist reports to the VP of Operations or designee. The incumbent in this position is responsible for monitoring and rating member service representatives based on established quality guidelines. Uses collected data to provide training to promote and improve quality of service delivery.

ESSENTIAL DUTIES AND RESPONSIBILITIES

  1. Provide ad-hoc training and guidance to member services and provider services representatives based on the results of quality audits.
  2. Conduct formal training sessions in both a face-to-face and virtual training environment.
  3. Conduct call quality audits on member services and provider services calls.
  4. Conduct auditing of call center documentation.
  5. Participate in regular QA calibration sessions with call center representatives and management.
  6. Report trends to leadership identified through the completion of call quality audits.
  7. Assess additional training needs and identify and report opportunities for additional training resources and resources to leadership.
  8. Design, develop, and implement new training within the department.
  9. Assist with the coordination and facilitation of new-hire and continuous training.
  10. Design and develop new quick reference guides and just-in-time communications to staff.
  11. Serve as a subject-matter expert for direct reports in the areas of Part C, Part D, Medicare Parts A & B, Medicare claims billing, and payments.

QUALIFICATIONS

  • Intermediate to advance knowledge in Microsoft Word and PowerPoint
  • Basic to intermediate knowledge of Microsoft Excel
  • Preferably some experience working with eKMS and/or LMS applications
  • Excellent written and oral communication skills

WORK EXPERIENCE

  • Minimum of two (2) years of member services experience, preferably in Medicare Advantage
  • Minimum of one (1) year of experience in a quality assurance role
  • Minimum of one (1) year of experience in a workplace learning role, including experience with facilitating virtual and face-to-face learning sessions and authoring workplace learning materials

LANGUAGE SKILLS

Bilingual English/Spanish fluency.