Quality Specialist - 26-36

PriMed Management Consulting • San Ramon, CA

1d

About The Position

At Hill Physicians Medical Group, we’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members. When you join our team, you’re making a great choice for your professional career and your personal satisfaction. At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are. We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right! The Quality Specialist evaluates the quality of service our representatives provide to members, providers, health plans, etc. As a subject matter expert and leader, this role assists Customer Service Management in improving the overall quality of the department and the performance of its individual members.

Requirements

• Minimum 2 years of Customer Service call center experience required
• High School diploma or GED required
• Experience working in a healthcare setting
• Working knowledge of Microsoft Office i.e. Excel, Outlook, Word
• Proficient in handling medical claims and eligibility inquiries
• Experience in dealing with various insurance types e.g. PPO, HMO, etc.
• Strong written and verbal communication skills
• Strong listening skills, able to synthesize information heard/seen to quickly make decisions
• Proven ability to problem solve
• Adept at managing change, change agent
• Able to acquire and maintain technical/professional expert knowledge including department policy/procedure, product, service, etc.
• Quality orientation, detail-oriented, thorough, accurate
• Able to provide feedback in a positive, nurturing manner, build trust, collaborative

Nice To Haves

• Experience using RingCentral Quality Management tool a plus

Responsibilities

• Use the quality monitoring system to listen to calls and view video of representative system navigation to evaluate the quality of service provided and ensure compliance with policies and procedures.
• Focus on the accuracy, professional delivery, and documentation of the interaction.
• Quality monitor other channels in a similar fashion.
• Participate in regular quality calibration sessions, help educate new hires on the quality monitoring process, and participate in new hire training debriefs.
• Provide regular feedback to management regarding the quality forms, process, etc. to help improve the overall program and quality performance of its representatives.
• Assist callers in queue when requested.
• Allow others to shadow to learn more about the position.
• Other tasks/projects as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 251-500 employees