Medicare Quality Assurance Coordinator

Please email if you are a candidate seeking a reasonable accommodation for the application and/or interview process. Schedule: Remote / Hybrid Compensation: $25.34 - $34.23 Jump into the new world of health insurance: At Blue Cross & Blue Shield of Rhode Island (BCBSRI), our business is healthcare. But our focus is on improving lives. Be part of a team that is large enough to make a difference but small enough to be innovative. Work in a rapidly changing field. Take a chance to be creative. Move outside the status quo. Shape new ideas with the power of a national brand behind you. Join others who know diversity is strength: We appreciate and celebrate everything that makes us unique: age, national origin, citizenship status, perspectives, experiences, physical or mental disability, military status, race, ethnicity, religion, gender, sexual orientation, gender identity and/or expression. Our diversity strengthens us as an organization and helps us better serve an increasingly diverse Rhode Island population. Why this job matters: Conduct quality assurance audits of customer service calls, monitoring for business standards and compliance with CMS requirements. Ensure audits are coordinated in a timely and thorough manner. Provide recommendations and action plans for agent education and process changes based on findings. Prepare audit summary reports, identifying agent performance and team trends. Provide guidance to and mentor less experienced auditors. What you will do: Coordinate quality assurance audits of customer service calls, monitoring for business standards and compliance with CMS requirements. Research and report audit findings to management and to customer service team through identified channels. Develop and maintain department training materials, workflows and policies and procedures. Ensure training documentation is accurate, up to date, and communicated timely. Ensure audits are planned and performed in accordance with policies and procedures. Assist with the development of scorecard measures for customer service staff. Provide education, coaching, and feedback to team based on audit findings. Respond to requests for information as related to data trends and ad hoc audits; triage information requests as appropriate. Serve as subject matter expert as related to department processes and requirements and serve as department liaison during system upgrades or enhancements. Assist with system testing as necessary. Prepare audit report findings for management review and other stakeholders. Lead and/ or participate in department initiatives and projects. Provide guidance and mentoring as needed. Perform other duties as assigned. What you need to succeed: A combination of education and related work experience Knowledge of Medicare requirements Knowledge of customer service and call center business processes Ability to research data, identify trends and recommend appropriate actions Detail oriented Ability to work successfully in a matrix environment Demonstrated written and verbal communications skills Ability to exercise sound judgment Ability to establish and maintain strong working relationships with various stakeholders Ability to organize work efficiently to meet established time and quality standards Good organization skills Good time management skills Proficiency with Microsoft Suite of products; i.e., Word, Excel, PPT, Share Point, etc Experience with AI technology a plus The extras: Associate's or Bachelor's degree in Business Management, Health or related field, or an equivalent combination of education and experience Two to four years' experience in quality assurance or customer service within a health insurance organization Knowledge of Blue Cross & Blue Shield products Experience conducting quality assurance reviews Strong written communication skills Location: BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role: In-office: onsite 5 days per week Hybrid: onsite 2-4 days per week Remote: onsite 0-1 days per week . -Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Florida, Georgia, Louisiana, North Carolina, Oklahoma, South Carolina, Texas, Rhode Island, Massachusetts, Connecticut and Virginia At Blue Cross & Blue Shield of Rhode Island (BCBSRI), diversity and inclusion are central to our core values and strengthen our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity, affirmative action employer. We provide equal opportunities without regard to race, color, religion, gender, age, national origin, disability, veteran status, sexual orientation, genetic information and gender identity or expression. The law requires an employer to post notices describing the Federal laws prohibiting job discrimination based on race, color, sex, national origin, religion, age, equal pay, disability, veteran status, sexual orientation, and genetic information and gender identity or expression. Please visit to view the "EEO is the Law" poster. Other details Pay Type Hourly Apply Now Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, Rhode Island, United States of America