Quality Assurance Specialist

About the role

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do. Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults. Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity.

Responsibilities

• Ensure compliance with regulatory and company/departmental standards by monitoring staff and processes, and implementing corrective action, as required.
• Improve service quality and efficiencies by developing and implementing standards, workflows and processes that are compliant with regulatory requirements and supports the delivery of service excellence.
• Maintain regulatory compliance by remaining knowledgeable of regulations and contractual requirements related to customer service operations, developing and implementing processes and policies/procedures that meet or exceed requirements.
• Ensure the SCAN commitment of service excellence to our customers by ensuring that staff consistently provide a level of service that meets or exceeds the customer’s expectation while being respectful, kind and knowledgeable about SCAN benefits and services.
• Identify and remediate deficient practices/processes by monitoring processes and staff interactions with customers, providing feedback, identifying trends and overseeing and measuring corrective actions.
• Provide management with feedback on staff performance and participate in coaching of the staff.
• Improve service quality by measuring the quality, effectiveness and efficiency of the customer experience and provide recommendations for improvement to management.
• Support the Member Services Trainer by providing feedback on training needs and assist in the development and presentation of training, as required.
• Maintain awareness of membership and service issues by generating reports, analyzing data to identify trends, and making recommendations for improvement.
• Contribute to team effort by accomplishing related results, as needed.
• Actively support the achievement of SCAN’s Vision and Goals.

Qualifications

• Preferred: Bachelor’s degree
• 5+ years’ preferably within healthcare industry
• Demonstrated efficiency/effectiveness in an environment with a high call volume; 1+ years of prior experience with Medicare benefits, including Medicare Advantage Plans preferred
• Experience in the healthcare, insurance or pharmacy industry highly desirable
• Excellent communication skills, both oral and written
• Strong interpersonal skills, including excellent verbal communication skills

Skills

• Knowledge of regulatory requirements and contractual obligations related to customer service operations
• Ability to develop and implement standards, workflows, and processes that meet or exceed regulatory requirements
• Strong problem-solving and critical thinking skills
• Effective communication and interpersonal skills
• Ability to monitor processes and staff interactions to identify and remediate deficient practices
• Ability to provide feedback and make recommendations for process improvements

Benefits

• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)- 11 paid holidays per year, 1 floating holiday, birthday off, and 2 volunteer days
• Excellent 401(k) Retirement Saving Plan with employer match
• Roadmap to Career Advancement

Pay

Base Pay Range: TBD

Schedule

Work Mode: Remote