Quality Assurance Lead

HealthPlanOne

5d•Hybrid

About The Position

HealthPlanOne's mission is to help people find the right health insurance at the right price, so they live healthier lives. We are committed to making the shopping process simpler. Our mission has never been more important than it is today. The Quality Assurance Lead will assist in training QA Specialists, audit scorecards, process appeals and create quality reports. The Quality Assurance Lead will serve as a subject matter expert for the QA Specialists.

Requirements

High school diploma or equivalent
Excellent written and oral communication
Ability to work under set production goals
Accurate data recording
Analytical, organized and detail oriented
Excellent proofreading skills
Knowledge of Excel and Outlook
Knowledge of CMS

Nice To Haves

Associate degree in business or related field
Quality assurance analyst/evaluator experience or a current and valid Life, Health and Annuity License (215)
Exposure to Medicare and other insurance products
Bilingual speaking skills (English and Spanish)

Responsibilities

Create training materials for agents, specialists, and ops leaders.
Spot check/audit auditors: randomly audit the work product from the Quality Team.
Create and distribute various client and Operations custom reports: Agent QA scores, appeals, other various quality & coaching reports.
Participate in client and Account Management meetings to provide input from the Lead’s specific line-of-business.
Meet with Operational Leaders to provide calibrations, reporting analysis and training sessions.
Attends Operations Supervisor/Agent QA coaching sessions as required to provide additional detail and/or clarity where needed in follow up to the audit and the QA coaching request.
Process appeals: Investigate, manually make changes, and document appeal findings.
Work side-by-side with internal quality assurance platform developers assisting with debugging, testing, troubleshooting, suggesting process enhancements, etc.
Assist with auditor training and alignment: /Ensure auditors stay aligned with material and systems, answering questions.
Serve as the dedicated Subject Matter Expert per the line of business.
Evaluates/audits calls and evaluate the quality of each call based on the quality guidelines and standards
Score each call based on compliance criteria
Resolve escalated issues with members, carriers and internal clients.
Perform other related duties as assigned