Quality Assurance Specialist
Steward Health Choice is dedicated to improving the health and well-being of the people and communities we serve.
Steward Health Choice believes in a personal approach to health care right in your community. We built our health care plan around you. Our goal is to give you quality health care, programs, and services to support you on your path to wellness.
Steward Health Choice provides exceptional customer service and culturally competent care through:
- Compassionate and responsive member services team
- Collaboration with community physicians to help members get the health care they need.
- Providing culturally competent health care, including extensive translation and interpretation services
- Health programs to help members and their families stay healthy
Position Purpose: The primary role of this position is to develop and follow Quality Monitoring Guidelines to provide a detailed description of the call quality performance requirements. This role will be responsible to monitor and evaluate all lines of Contact Center Operations business as well as monitor and evaluate calls for other departments taking calls from both members and/or providers.
- Monitoring of all phone representatives for all lines of business a minimum of 3 calls per month (may vary depending on line of business) ensuring adherence to contractual and Steward Health Choice guidelines, and facilitate cross-training for increased responsiveness and departmental efficiency
- Complete electronic monitor forms on each call, record and communicate monitor results to phone representative
- Report results to management team
- Partner with department trainers to enhance training materials and develop ongoing training pertaining to quality assurance
- Review and access usage of correct action codes, and appropriate documentation in delivery systems (MedMC, Care Radius, etc.)
- Complete and deliver any quality reports to the respective lines of business
- Ensure confidentiality and not release any information except to persons authorized by Steward Health Choice or as required by law (URAC, v7.1, CORE 16b).
- Conduct ‘spot’ monitoring on an as needed basis
- Conduct ‘side by side’ monitoring on an as needed basis
- Any other activities as directed by department Leadership
- Contact Center management staff is alerted to potential quality issues in a timely manner
- Results of the monitoring will be used to educate representatives about the correct information they provide to callers, appropriate telephone language and manners, and to instill pride in providing high quality customer service over the phone. Results will also affect performance evaluations. Repeated poor ratings of telephone service shall result in disciplinary action
- High School diploma/GED
Years of Experience:
- At least one (1) year experience as a trainer preferred
- At least one (1) year call center environment preferred
- At least two (2) years customer service experience
- At least two (2) years Medicaid and Medicare experience, preferably AHCCCS
- Microsoft office; Word, Excel
- Bilingual (English and Spanish) preferred
- Effective time management and organizational skills
- Effective interpersonal and communication skills
- Use of a multi-line phone
- Able to handle fast paced high stress situations
- Complete tasks with little supervision
- Ability to lead others
- Ability to think analytically and make independent decisions
- Ability to manage large workload
- Ability to maintain a positive work environment for employees
- Ability to maintain positive work relationships
- Handle multiple and changing priorities at a fast pace
- Ability to manage multiple projects and prioritize work tasks to adhere to deadlines and identified time frames