Quality Review Customer Service Job

JOB SUMMARY

Responsible for auditing customer advocate responsibilities to ensure the maintenance of quality assurance and customer satisfaction. Provides feedback to leadership regarding audit findings and provides administrative support to the department.

WHAT IS EXPECTED (ESSENTIAL FUNCTIONS)

Responsible for system administration of desktop real-time knowledge tool, ensuring that the tool’s content consistently support adherence to regulatory guidelines, internal policies and procedure, and departmental accuracy standards. Also accountable for usage control, content audit, and user training.

Completes audit checklist on phone calls and emails sent by customer service staff and vendor to ensure policies and procedures are being followed.

Responsible for running audit reports and creating charts/graphs to demonstrate trends exhibited by customer service staff in order to aid in the training/education of staff in a timely manner. Issues that are categorized as compliance concerns may be reported on an individual bases and as soon as possible.

Communicates significant audit findings to management discovered during a review in a timely manner.

Performs follow-up reviews for operational and compliance issues.

Develops practical recommendations to effectively resolve member and provider complaints and questions before it reaches the complaint process.

Ensures that the customer advocate standard operating procedures consistently support adherence to regulatory guidelines, internal policies and procedures and departmental accuracy standards.

Serves as a customer advocate by communicating to members and providers information regarding policies, procedures and services of the SWHP to ensure complete understanding of the plan.

Provides administrative support to the department and participates in special projects when needed.

Demonstrated a comprehensive working knowledge of customer service processes and policies.

The information contained in this job description is intended to describe the essential job functions required of those assigned to this job. It is not intended to be an exhaustive list of all responsibilities, duties, knowledge, skills, and abilities needed to perform the job. Please note that management retains the right to assign or reassign duties and responsibilities to this job at any time. The ability to competently perform all the essential duties of the position, with or without reasonable accommodation, demonstrated commitment to effective customer service delivery, integrity, and the ability to work productively as a member of a team or work group are basic requirements of all positions at Baylor Scott & White Health

KNOWLEDGE, SKILLS AND ABILITIES

Associates degree or equivalent formal training preferred

Customer service experience in diverse customer base

Experience with Microsoft Word, Excel, Amisys, and Macess

Excellent written and oral communication skills

Ability and willingness to accept delegated tasks and responsibilities

Ability to maintain strict confidentiality at all times

Must possess good judgment, attention to detail, integrity, dependability, objectivity, and

strong analytical skills

Qualifications

High School Diploma/ GED Equivalent

3 years experience

Primary Location

:

US-Texas-Temple

Work Locations

:

S&W Health Plan – West Campus

1206 W Campus Dr

Temple

76502

Job

:

Health Plan

Organization

:

Scott & White Health Plan

Schedule

:

Full-time

Shift

:

Day Job

Employee Status

:

Regular

Job Type

:

Standard

Job Level

:

Individual Contributor

Job Posting

:

Mar 23, 2017, 10:21:47 AM