Professional, Care Center Quality Assurance

MVP Health Care • Rochester, NY

19d • Hybrid

About The Position

Join Us in Shaping the Future of Health Care At MVP Health Care, we’re on a mission to create a healthier future for everyone. That means embracing innovation, championing equity, and continuously improving how we serve our communities. Our team is powered by people who are curious, humble, and committed to making a difference—every interaction, every day. We’ve been putting people first for over 40 years, offering high-quality health plans across New York and Vermont and partnering with forward-thinking organizations to deliver more personalized, equitable, and accessible care. As a not-for-profit, we invest in what matters most: our customers, our communities, and our team. What’s in it for you: Growth opportunities to uplevel your career A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team Competitive compensation and comprehensive benefits focused on well-being An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District, one of the Best Companies to Work For in New York, and an Inclusive Workplace. You’ll contribute to our humble pursuit of excellence by bringing curiosity to spark innovation, humility to collaborate as a team, and a deep commitment to being the difference for our customers. Your role will reflect our shared goal of enhancing health care delivery and building healthier, more vibrant communities.

Requirements

• Associate degree Business/Management or related field
• Minimum 3 – 5 years related experience required
• Excellent personnel and training management skills
• Excellent written and verbal skills
• Proven organizational and analytical skills
• Attention to detail and quality service
• Microsoft Office (Excel, Word, PowerPoint, Access)
• Strong working knowledge of Facets and Dynamics
• Curiosity to foster innovation and pave the way for growth
• Humility to play as a team
• Commitment to being the difference for our customers in every interaction

Responsibilities

• Reviews and facilitates general quality overview and improvements in all areas of Customer Care Center (CCC) and acts as support in training, employee development, and process improvements.
• Facilitates Customer Care Center Call Coaching (Call Quality Review) program.
• Identifies and implements process improvement initiatives, both at a departmental and corporate level, to increase operational efficiency and overall effectiveness of CCC operations and workflows.
• Performs statistical analysis to review opportunities for process and workflow improvement opportunities and implementation of project plans to facilitate improvements.
• Coordinates training as of a result of involvement in department related corporate projects.
• Oversees and coordinates MVP HIPAA standards including employee training and development, policy and process review and implementation, HIPAA compliance review, and acting as the HIPAA subject matter expert.
• Acts as a primary Quality Assurance reviewer for departmental initiatives including one call resolution and other departmental standards to ensure proper auditing controls are in place and adhered to on a consistent basis.
• Assists department in handling member concerns, issues, and complaints, and may include direct member contact and issue resolution, as well as extensive interaction with other MVP departments.
• Oversees and participates in department’s correspondence process including correspondence development and procedural development.
• Conducts audits to ensure compliance with procedural and quality standards.
• Communicate with outside contacts including NYS Department of the Attorney General, as well as compliance for required regulatory Managed Care Requests.
• Manages tasks including operational objectives, task designation, provides input into employee performance evaluations and assessments, and daily operations.
• Assists department in handling member concerns, issues, and complaints, and may include direct member contact and issue resolution, as well as extensive interaction with MVP departments.
• Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.

Benefits

• Growth opportunities to uplevel your career
• A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team
• Competitive compensation and comprehensive benefits focused on well-being
• An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District, one of the Best Companies to Work For in New York, and an Inclusive Workplace.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 501-1,000 employees