[Hiring] Eligibility Review Specialist @Conduent

Role Description

The Eligibility Review Specialist reports directly to the EL Review Supervisor, ensuring elements of the Quality Assurance Plan are carried out and contractually required performance requirements are maintained. The role involves performing quality assurance reviews on Call Center calls and various aspects of the business, based on the approved Quality Assurance (QA) Plan and QA policies and procedures.

• Review eligibility cases meeting all production and quality goals.
• Maintain technical and program policy proficiency in the NJ Family Care program and maintain proficiency in contract requirements.
• Monitor and assess individual/group performance against established standards/requirements.
• Enter QA review results into database for quality assurance scorecard reporting.
• Identify, develop, and assist in the execution of corrective action measures as needed to maintain or re-gain compliance in a timely manner.
• Provide feedback to leadership team and assist in addressing education/training needs with Project Director, Managers, and Supervisors, including preparing summaries and presentations when appropriate.
• Compile and analyze data to assist with contractually required, ad hoc, and internal management reports as needed.
• Participate in and contribute to the quality improvement process.
• Assist in collecting information for staff performance reviews by monitoring individual and group performance against established standards.
• Provide feedback to leadership staff of areas for improvement.
• Work with management team to develop and execute corrective action plans in the event of contractual non-compliance.
• Participate in training sessions.
• Other duties as assigned.

Qualifications

• Currently working within the NJEB Eligibility Business Unit.
• Associates degree required; relevant quality assurance experience can be substituted for education on a one-for-one basis.
• A minimum of two (2) years of experience providing corporate quality assurance.
• Experience utilizing state-of-the-art technology and quality methods to implement improvements and changes in an organization.
• Experience in public sector administration, outsourcing/production environment, Medicaid and/or CHIP is a plus.
• Outstanding oral and written communication skills, strong interpersonal skills, and superior organizational abilities.
• Ability to take initiative, maintain confidentiality, meet deadlines, and work in a team environment.

Requirements

• Prioritize required tasks along with special project demands.
• Extreme attention to detail.
• Thorough understanding of all areas of operations in order to evaluate quality in work processes.
• Problem solve through analysis and ongoing feedback.
• Develop corrective action plans for areas not meeting performance standards through data analysis and trend identification.
• Ability to champion change within a formal organization.
• Ability to handle multiple tasks and meet deadlines; flexibility under pressure.
• Ability to work with people of diverse backgrounds.
• Ability to maintain strict confidentiality.
• Capable of working independently.
• Ability to use MS Word, MS Excel, and MS Outlook required.
• Overtime, evening, and some weekend hours; fast pace.

Benefits

• Health insurance coverage.
• Voluntary dental and vision programs.
• Life and disability insurance.
• Retirement savings plan.
• Paid holidays.
• Paid time off (PTO) or vacation and/or sick time.