Job Description

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 Call Center Operations business as well as monitor and evaluate calls for other departments taking calls from both members and/or providers.

Oversee day to day operations set forth by the Department Management: Call Center Operations is committed to the delivery of quality services to its members and providers through the telephone system.

  • 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 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)
  • Meet with Department Management on a regular basis to assess departmental operation and activities
  • Complete and deliver any quality reports to the respective lines of business
  • Ensure confidentiality and not release any information except to persons authorized by 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

Knowledge:

Proper customer service technique

Microsoft office; Word, Excel

Prefer Bilingual in Spanish

Skills:

Bilingual (English and Spanish) preferred

Computer experience necessary

Effective time management and organizational skills

Effective interpersonal and communication skills

Use of a multi-line phone

Abilities:

Ability to handle upset members

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

Work cooperatively, positively, and collaboratively in an interdisciplinary team

Work respectfully and positively with members and providers

Ability to manage multiple projects and prioritize work tasks to adhere to deadlines and identified time frames

Education:

High School Diploma or G.E.D. preferred

Some college preferred in business or health care desired

Experience:

At least two (2) years customer service experience

At least two (2) years Medicaid and Medicare experience, preferably AHCCCS.

At least one (1) year call center environment preferred

At least one (1) year experience as a trainer preferred

Application Instructions

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