Quality Assurance Specialist, Member Experience

Job Number: 2148

Workplace Type:

Position Title: Quality Assurance Specialist

External Description:

Quality Assurance Specialist

Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.

By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.

 

Position Summary:
Responsible for the monitoring of the Member Experience call center and respective areas for quality and effectiveness to ensure that callers are met with the optimal member experience. Provides ongoing support of call performance improvements and overall operational consistency.

General Duties/Responsibilities:

(May include but are not limited to)

• Validates quality of customer service provided by the Member Experience Department staff.
• Completes a call monitoring evaluation form in its entirety for each call monitored and evaluated.
• Stays abreast current workflow and call handling procedures, adapting to changes in workflow to ensure accuracy and efficiency of call evaluations.
• Recognize and identifies possible training issues and error trends; reports findings as required.
• Responsible for ensuring HIPAA compliance through call monitoring and evaluation for the Protection of Health Information.
• Required to audit available call audio, screen capture, and call documentation specifically and sufficiently for adherence with department policy and procedures.
• Responsible for preparing a weekly / monthly report and analysis of call performance to include findings and recommendations to ensure quality and effectiveness of the Quality Assurance program.
• Participate in roundtable sessions as needed to review and make recommendations regarding efficiency improvements, design of call monitoring forms and quality standards.
• Maintains confidentiality and upholds standards for privacy and data integrity and security of the Member Experience telephone calls monitored and/or evaluated.
• Assists with the development of training tools in collaboration with the department trainer; assists with departmental training as needed.
• Foster good corporate relations by practicing good customer service principles (i.e., positive attitude, helpful, etc.).
• Perform other duties as assigned.

Minimum Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Minimum Experience:
   1. Two to three years related experience and/or training; or equivalent combination of education and experience.
   2. Two years customer service/telemarketing experience.
   3. Related experience, preferably in the Medicare Managed Care industry.
2. Education/Licensure:

1. 1. High school diploma or general education degree (GED)

1. Other:

1. 1. Fluency in Spanish language, required.
   2. Language Skills:  Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals.  Ability to write routine reports and correspondence.  Ability to speak effectively before groups of customers or employees of the organization.
   3. Mathematical Skills:  Ability to add and subtract two digit numbers and to multiply and divide with 10’s and 100’s.  Ability to perform these operations using units of American money and weight measurement, volume, and distance.
   4. Reasoning Skills:  Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.  Ability to deal with problems involving a few concrete variables in standardized situations.
   5. Computer Skills:  Strong computer skills.
   6. Other Skills and Abilities:

1. Computer literate, typing 40+ words per minute.
2. Excellent communication skills, oral and written.

1. Work Environment:
   1. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
      1. The noise level in the work environment is usually moderate.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
2. The employee is frequently required to walk; stand; reach with hands and arms.
3. The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl.
4. The employee must occasionally lift and/or move up to 20 pounds.
5. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

City: Orange

State: California

Location City: Orange

Location State: California

Community / Marketing Title: Quality Assurance Specialist, Member Experience

Company Profile:

By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is revolutionizing health care for seniors! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

EEO Employer Verbiage:

 

Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].