Customer Engagement and Experience Quality Assurance Auditor II

Salary Range

Salary Range: $55,245.00 (Min.) - $69,045.00 (Mid.) - $82,867.00 (Max.)

About the role

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.

Responsibilities

• Conduct audits to ensure that regulatory and quality requirements were met across all verticals under CE&E.
• Conduct random member audits and surveys to ensure the member experience has a positive outcome.
• Monitor call center, including CC Leads, Outbound and Outreach, Ansafone, Web Inquiries, Member Relations Unit (MRU), and Appeals and Grievance (A&G), performance against key performance indicators (KPI) and recognize trends that require individual or group retraining.
• Review audits and analyze the data and documentation and provide recommendations to management.
• Track and trend daily error reports, analyze results from the internal sources, and recommends quality improvements.
• Assist in developing Desk Level Procedures (DLP) for all supporting units.
• (65%) Perform and assist with weekly calibrations.
• Assist with new hire training and/or up training, assess class curriculum, desk level procedures, and recommend changes as necessary.
• Compile quality data on a daily/monthly basis to measure compliance with internal policies and procedures as well as regulatory requirements.
• Review quality reports, outcomes, recommends corrective action plans (CAP) as needed and report irregularities or vulnerabilities to appropriate parties as deemed necessary.
• Frequently compile quality data to measure compliance as well as regulatory requirements. Review quality reports, outcomes, recommend corrective action plans as needed and report irregularities or vulnerabilities to appropriate parties as deemed necessary.
• Provide one-on-one coaching assessments to all pertinent departments.
• Consistently participate in quality initiatives and special project task forces as deemed necessary.
• Work with management to develop quality tools to monitor potential departmental vulnerabilities.
• Provide senior management with analysis on the error trends and provide recommendations for improvements.
• Responsible for all lines of business (LOB), systems used at L.A. Care, reviews targeted audits of customer interaction documentation.
• Affix to the department with call handling, as needed.

Requirements

• At least 2 years of quality assurance experience, preferably in healthcare's Customer Engagement and Experience or Quality Assurance OR at least 4 years of contact center experience in managed care, healthcare, and/or health insurance.
• Knowledge of and experience of Medi-Cal, Medicare, and Covered California.
• Good verbal and written communication skills. Strong analytical skills, excellent technical skills, and attention to detail.
• Intermediate knowledge of Microsoft (MS) Office.
• Ability to coach and train employees.
• Working knowledge of a Customer Relationship Management (CRM), Automated Eligibility Verification System (AEVS), and other benefit eligibility programs.

Qualifications

• High School Diploma/or High School Equivalency Certificate.

Skills

• Strong research skills.
• Intermediate knowledge of Microsoft (MS) Office.
• Ability to coach and train employees.
• Working knowledge of a Customer Relationship Management (CRM), Automated Eligibility Verification System (AEVS), and other benefit eligibility programs.

Benefits

L.A. Care Offers a Wide Range Of Benefits Including Paid Time Off (PTO)Tuition ReimbursementRetirement PlansMedical, Dental and VisionWellness ProgramVolunteer Time Off (VTO)

Pay

Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

Schedule

N/A