Quality Reviewer- Enrollment and Billing

Blue Cross and Blue Shield of Louisiana•Baton Rouge, LA

3d•Hybrid

About The Position

The Customer Service Quality Reviewer I is responsible for evaluating customer interactions to ensure compliance with departmental policies, business requirements, regulatory standards, and customer service expectations. This position performs quality audits of customer contacts, documents findings, documents audit findings, identifies audit-based trends, and provides objective feedback to support compliance, service consistency, and member experience. This position partners with operational leadership, trainers, and customer service staff to promote consistency, accuracy, compliance, and a positive member experience. This position is accountable for complying with all laws, regulations, and organizational policies associated with assigned responsibilities. The Customer Service Quality Reviewer I works independently while following established quality monitoring standards and procedures. The role is responsible for reviewing customer interactions, documenting audit results, identifying recurring audit trends, escalating concerns as appropriate, supporting assigned quality improvement activities, and assisting with onboarding and employee development through activities such as Connect Days and Helpline support.

Requirements

High School Diploma or equivalent is required
2 years in either Enrollment & Billing, Call Center, and/or Claims analyzing transactions is required
Strong verbal and written communication skills
Strong organizational and analytical abilities
Ability to objectively evaluate customer interactions
Ability to maintain confidentiality and professionalism
Ability to identify trends and opportunities for improvement
Knowledge of customer service principles and quality standards
Ability to provide constructive feedback
Working knowledge of Microsoft Office applications
Ability to work independently and collaboratively
Ability to adapt to changing priorities and business needs
Basic understanding of HIPAA requirements and healthcare operations

Nice To Haves

Associate degree preferred
Experience reviewing customer interactions, interpreting policies and procedures, or supporting operational quality initiatives preferred.

Responsibilities

Conduct quality reviews of inbound and outbound customer interactions, including telephone calls, emails, written correspondence, and other communication channels.
Evaluate interactions for accuracy, compliance, professionalism, customer service effectiveness, and adherence to established standards.
Review customer contacts for proper authentication, documentation, and benefit accuracy.
Verify compliance with departmental policies, procedures, HIPAA requirements, and regulatory guidelines.
Complete assigned audits within established productivity and timeliness expectations.
Maintain accurate records of completed audits and supporting documentation.
Document audit findings in designated quality systems.
Ensure findings are supported by documented evidence and quality standards.
Maintain audit files and review histories for reporting purposes.
Provide objective and fact-based feedback through audit results.
Support trainers by identifying coaching opportunities.
Participate in side-by-side onboarding, monitoring activities for new hires when assigned.
Reinforce quality expectations and established procedures.
Assist with identifying educational opportunities for representatives.
Monitor audit findings for recurring performance trends and operational concerns.
Identify audit-based trends that may indicate process gaps, training needs, or quality risks.
Escalate compliance concerns, customer experience issues, and systemic risks to leadership.
Participate in quality improvement initiatives and special projects.
Share documented findings and recommendations with leadership to support service quality and member experience improvements.
Participate in calibration sessions to ensure consistency in audit scoring and interpretation.
Maintain current knowledge of quality standards and audit methodologies.
Assist with validating quality guidelines and audit tools.
Support initiatives that improve audit consistency and reliability across the department.
Maintain knowledge of products, benefits, policies, procedures, and operational changes.
Complete required training and continuing education activities.
Support departmental projects and initiatives as assigned.
Perform other duties within the scope of responsibility as assigned.
Perform other job-related duties as assigned, within your scope of responsibilities.