Customer Engagement and Experience Quality Assurance Auditor II

L.A. Care Health Plan•Los Angeles, CA

17d•$55,245 - $82,867

About The Position

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. 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 Customer Engagement and Experience or Quality Assurance OR at least 4 years of contact center experience in managed care, healthcare, and/or health insurance.
Knowledge of and experience of Medi-Cal, Medicare, and Covered California.
Good verbal and written communication skills.
Strong analytical skills, excellent technical skills, and attention to detail.
Excellent technical skill.
Strong research skills.
Intermediate knowledge of Microsoft (MS) Office.
Ability to coach and train employees.
Working knowledge of a Customer Relationship Management (CRM), Automated Eligibility Verification System (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.

Responsibilities

Conduct audits to ensure that regulatory and quality requirements were met across all verticals under CE&E.
Conduct 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 (A&G), performance against key performance indicators (KPI) and recognize trends that require individual or group retraining.
Review audits and analyze the data and documentation and provide recommendations to management.
Track and trend daily error reports, analyze results from the internal s, and recommends quality improvements.
Assist in developing Desk Level Procedures (DLP) for all supporting units.
Perform and assist with weekly calibrations.
Assist with new hire training and/or up training, assess class curriculum, desk level procedures, and recommend changes as necessary.
Compile quality data on a daily/monthly basis to measure compliance with internal policies and procedures as well as regulatory requirements.
Review quality reports, outcomes, recommends corrective action plans (CAP) as needed and report irregularities or vulnerabilities to appropriate parties as deemed necessary.
Frequently compile 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.
Provide one-on-one coaching assessments to all pertinent departments.
Consistently participate in quality initiatives and special project task forces as deemed necessary.
Work with management to develop quality tools to monitor potential departmental vulnerabilities.
Provide senior management with analysis on the error trends and provide recommendations for improvements.
Responsible for all lines of business (LOB), systems used at L.A. Care, reviews targeted audits of customer interaction documentation.
Assist the department with call handling, as needed.
Performs other duties as assigned.