Call Center Quality Assurance Auditor (Centrum Health)

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We are transforming healthcare to be value-driven, creating a seamless, consumer-centric care experience that maximizes value for all.

We believe that all health consumers are entitled to high quality, coordinated healthcare. We uniquely align the interests of health consumers, providers, and payors to make high-quality healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.

JOB SUMMARY 

The Quality Assurance Auditor for the Call Center is responsible for ensuring the highest standards of service quality and compliance with HIPAA laws by monitoring and evaluating live calls, aiding agents, and reporting on performance. This role involves collaborating closely with agents and supervisors to assess and enhance customer service skills, product knowledge, and overall performance, while also identifying and addressing training needs. 

DUTIES & RESPONSIBILITIES 

The Quality Assurance Auditor job description is intended to point out major responsibilities within the role, but it is not limited to these items. 

• Provide real-time support to agents on live calls to ensure accurate and effective customer interactions.
• Ensure Call Center Representatives comply with HIPAA laws and company policies during customer interactions.
• Report employee-related findings and situations to immediate supervisors and document all audits in the database.
• Work side by side with agents and supervisors to monitor calls, assess customer service skills, and evaluate product knowledge.
• Analyze departmental training needs and communicate findings with supervisors to inform training programs.
• Recognize and commend outstanding CSR performance as appropriate.
• Assist in developing action plans to enhance CSR knowledge and skills.
• Undertake special projects as assigned to improve call center operations and service quality.
• Ensure patient inquiries are handled professionally and courteously.
• Assure the quality of service in call center interactions by monitoring calls and providing feedback.
• Utilize a coaching form to give structured feedback based on monitoring sheet criteria.
• Identify coaching opportunities using established criteria and provide guidance to improve performance.
• Meet established metrics set by Contact Center Management on a daily, weekly, and monthly basis.
• Conduct and/or process orientations related to disenrollment, outbound calls, member satisfaction surveys, and other related activities.
• Maintain up-to-date knowledge through continuous learning, including trainings, emails, one-on-ones, and staff meetings.
• Report any unusual situations identified during member and/or provider contact.
• Perform other duties as assigned to support the call center’s goals and objectives.

EDUCATION AND PROFESSIONAL EXPERIENCE 

• Bachelor’s degree in business administration, communications, healthcare management, or a related field, or equivalent work experience.
• Minimum of 3-5 years of experience in a call center environment, with at least 2 years in a quality assurance or supervisory role.
• In-depth understanding of HIPAA laws and compliance requirements in a call center setting.
• Proven ability to analyze performance metrics, identify training needs, and implement effective coaching and development plans.
• Proficient in using call center software, quality monitoring tools, and database management systems.

PROFESSIONAL COMPETENCIES 

• Strong verbal and written communication abilities, with the capability to provide clear, constructive feedback to call center representatives.
• Excellent analytical and problem-solving skills to evaluate call quality, identify areas for improvement, and develop actionable plans.
• Demonstrated leadership and team-building skills, with the ability to motivate and guide staff towards achieving performance targets and maintaining high service standards.

As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of NeueHealth, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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