Operations Quality Assurance Specialist - Full-time / Part-time

Key Responsibilities/Duties – what you will be doing

• Listen to and score Medicare Member, Provider and Helpdesk Services calls. Identify educational needs for new and existing Point32Health employees through call monitoring and recommend appropriate training intervention. Monitor and assess staff progress and communicate concerns and recommendations to appropriate supervisor/manager. Create and maintain relationships with supervisors to communicate on their staff’s performance. Work with Training to identify trends and training opportunities.
• Attend several meetings including but not limited to staff meetings, calibration sessions and monthly quality review meetings.
• Present a Quality Assurance overview during new hire training. Facilitate calibration sessions with the new hires to demonstrate how scoring is based on the QA Call Guidelines.
• Maintain a high degree of subject area expertise by attending training, Member All Staff meetings and reviewing task flows in the document management system.
• Update and track quality program based on quality scores.
• Carry out special projects and serve on committees as requested by the Supervisor Operations Quality Assurance.

Qualifications – what you need to perform the job

EDUCATION, CERTIFICATION AND LICENSURE:

• Associates Degree or equivalent relevant work experience is required
• Bachelor’s Degree is preferred.
• Knowledge of Microsoft Word, Excel, PowerPoint, and the ability to learn other office systems desired.

EXPERIENCE (minimum years required):

• A minimum of one year experience and a history of high-quality scores in the Point32Health Customer Service is required.
• Two or more years of experience are preferred.
• Must have strong interpersonal, organization, analytical, and communication skills.
• Must be able to be objective and be able to multitask.

SKILL REQUIREMENTS:

• Requires high degree of organization.
• Must be able to work within deadlines.
• Requires excellent interpersonal skills, a high level of diplomacy, and the ability to work with diverse populations from various departments.
• Requires excellent oral and written communication skills.
• Must possess initiative, balanced judgment, keen attention to detail, and the ability to plan, coordinate, and prioritize their own and others’ work to ensure maximum efficiency.
• Ability to learn and absorb complicated information quickly is extremely desirable.
• Must be able to work cooperatively as a team member.
• Must be willing to act as an instructor and mentor to all internal and external customers.

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel):

• Must be able to work under normal office conditions and work from home as required.
• Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
• May be required to work additional hours beyond standard work schedule.
• Operations Quality Assurance is a fast-paced office environment requiring that multiple demands be handled simultaneously.
• Must be able to exercise mature, appropriate judgment.
• Must be able to prioritize workload.
• Must effectively utilize various sources of communication to impart information to others.
• Must be able to move PC’s and furniture to set-up call monitoring station, if necessary.
• Must show scheduling flexibility to meet the needs of the department.
  

Commitment to Diversity, Equity & Inclusion

Point32Health is committed to making diversity, equity, and inclusion part of everything we do—from product design to the workforce driving that innovation. Our DEI strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities.

This job has been posted by Ignyte AI on behalf of Point32Health. Ignyte AI is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of Ignyte AI not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law.

Req ID: R7861