Customer Engagement and Experience Quality Assurance Auditor II

L.A. Care Health Plan•Los Angeles, CA

About The Position

The Customer Engagement and Experience (CE&E) Quality Assurance Auditor II is responsible for monitoring and actively influencing the Contact Center (CC) team’s quality performance, ensuring that the quality requirements in place are fulfilled and the goals are consistently achieved. This position will analyze quality results and performance to identify and optimize processes and support staff development, in partnership with the Quality Assurance (QA) Management. This position will identify processes, situations, and opportunities where improvement is needed and be responsible for creating performance reports and action plans. The position will maintain a high level of based knowledge on benefits for all product lines (Medi-Cal, CMC, PASC, Healthy Kids and Covered California) as well as serve and act as the department's Subject Matter Expert (SME). This position will assist in the development of tools and procedures established to audit each vertical under the CE&E. In addition, this position will make recommendations for individual and group training/retraining and process improvements. This position will assist in the development of training materials delivered to various internal departments and offsite CC vendor to measure product knowledge. As needed, this position will be assisting and conducting training for new onboarding QA staff and assist and support trainers with academy classes.

Requirements

High School Diploma/or High School Equivalency Certificate
At least 2 years of quality assurance experience preferably in healthcare's Member Services or Quality Assurance.
Knowledge of and experience of Medi-Cal, Medicare, and Covered California.
Good oral and written communication skills.
Strong analytical skills, excellent technical skills and attention to detail.
Excellent technical skill.
Strong research skills.
Intermediate knowledge of MS Office.
Ability to coach and train employees.
Working knowledge of a CRM, AEVS, and other benefit eligibility programs.

Nice To Haves

Associate's Degree
Bilingual in one of LA Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese.
American Society for Quality - Certified Quality Auditor (ASQ - CQA) Certification

Responsibilities

Conduct audits to ensure that regulatory and quality requirements were met across all verticals under CE&E.
Conducts random member audits and surveys to ensure the member experience has a positive outcome.
Responsible for monitoring call center, including CC Leads, Outbound and Outreach, Ansafone, Web Inquiries, Member Relations Unit (MRU), and Appeals and Grievance, performance against key performance indicators and recognizes trends that require individual or group retraining.
Conducts/reviews audits and analyzes the data and documentation and provides their input to management for review.
Tracks and trends daily error reports, analyze results from CC, MRP, Medicare, MRU, Outbound and Outreach, and L.A. Care Covered scorecards and recommend quality improvements for the CC Department.
Create and assist in developing Desk Level Procedures (DLP) for all supporting units.
Performs and assist with weekly calibrations.
Assists with new hire training (CC and QA) and/or up training, assess class curriculum, DLP, and recommend changes as necessary.
Compiles quality data on a daily/monthly basis to measure compliance with internal policies and procedures as well as regulatory requirements.
Reviews quality reports, outcomes, recommends corrective action plans as needed and reports irregularities or vulnerabilities to appropriate parties as deemed necessary.
Frequently compiles quality data to measure compliance as well as regulatory requirements.
Review quality reports, outcomes, recommend corrective action plans as needed and report irregularities or vulnerabilities to appropriate parties as deemed necessary.
Provides 1:1 Coaching Assessments to all pertinent departments.
Consistently participates in quality initiatives and special project task forces as deemed necessary.
Works with unit managers to develop quality tools to monitor potential departmental vulnerabilities (Membership Accounting, Call Center Unit, Outbound and Outreach, and Member Relations Unit).
Provides unit managers and departmental director with analysis on the error trends and provide recommendations for improvements.
Serves as the subject matter expert for all Lines of Business (Medi-Cal, CMC, PASC/SEIU, Healthy Kids, L.A. Care Covered...); in addition to programs used at L.A. Care: MHC, MEIS, QNXT, QMEIS, IVR, NICE, MEDACCESS, TTY, SALESFORCE, MEDIASENSE, CISCO FINESSE, WEX CALLBACK and RETRO Process, AEVS, IHSS Website, and Provider Search Oracle.
Reviews targeted audit text documentation (MIU, CC, MRP and Member Relations) and update quality screens via NICE/Access/MHC/MEIS/QMEIS software.
The QA is also responsible for assisting Call Center with call intake as needed.
Performs other duties as assigned.