GENERAL SUMMARY: Monitor and assess processes and workflows to insure staff maintains both quality and production measures. To provide ongoing reporting and feedback to both Customer Service Specialist and management staff regarding performance. Measure and implement effort to maintain or increase the quality of work performed within Customer Service. Conduct random audits and quality checks to ensure member inquiries are handled professionally and processed in an appropriate manner. Coordinate and facilitate calibration sessions. Facilitate training for new hires and current staff regarding the audit process and departmental quality expectations.
PRINCIPAL DUTIES AND RESPONSIBILITIES: - Perform call monitoring (recorded and live) to ensure Customer Service specialists are in compliance with the rules and regulations of the organization as well as with NCQA and CMS requirements.
- Provide coaching, just-in time feedback, and oversight for employees based upon individual performance needs identified through quality audit trends and data collection.
- Evaluate and monitor new staff while in training , assisting specialists with handling calls in the most effective and efficient manner while ensuring the level of customer service is not negatively impacted.
- Provide feedback regarding staff and process performance using both survey and technology to increase service levels. Report outcomes to leadership on an ongoing basis. Develop and implement additional programs using technology to support those efforts.
- Randomly monitor mystery shop inquiries (both written and verbal), review PEGA cases and report feedback to leadership and specialist regarding individual, sectional and departmental performance.
- Act as a liaison between support departments and Training Consultants regarding performance related issues, keeping open communication to identify additional support needs.
- Review processes used within Customer Service to identify systemic issues and partner with process owners to improve service. Participate in continuous
improvement workshops and other forums aligned with quality assurance and improvement. - Utilize quality monitoring system to compile and track performance at team and individual level. Review and assess all performance reporting data and identify gaps in required reporting. Prepare and analyze internal and external quality reports for leadership review.
- Identify best in class service providers and routinely report on industry trends in service. Identify measures needed to increase overall performance.
- Audit cases and inquiries to ensure NCQA standards for services are being met across product line.
- Coordinate and facilitate calibration sessions for call center and vendor leadership.
- Perform other related duties as assigned.
(non-exempt/clerical union position) EDUCATION/EXPERIENCE REQUIRED: - Associate's Degree with a major in Business Administration or related field.
- Related and relevant experience may be considered in lieu of academic requirements. Related experience is defined as eight (8) years' experience in a call center with a minimum of two (2) years as a lead worker within an insurance, healthcare or government regulated industry.
- Minimum of two (2) years of experience in call center customer service.
- Minimum of one (1) year of experience conducting quality audits.
- Experience providing coaching, feedback, and facilitating training.
- Experience implementing process change, data analysis, and trend reporting.
- Experience in research and quality improvement.
- Excellent documentation skills.
- Excellent verbal and written communication skills.
- Self-directed and self-motivated.
- Strong interpersonal skills and discretion.
- Organizational and time management skills.
- Problem solving and decision making ability.
- Strong understanding of HAP's health care delivery system.
- Knowledge of HAP's benefits, riders, etc.
- Understanding of the functions of support departments requiring frequent interaction with Client Services.
- Strong understanding of the processes used with Client Services.
- Coaching and counseling.
- Organization and planning.
- Leadership and management.
- Quality improvement.
Additional Information
- Organization: HAP (Health Alliance Plan)
- Department: Customer Service Admin
- Shift: Day Job
- Union Code: Office/Non-Exempt, HAP