[Hiring] Internal QA/QC Specialist @QA/QC

Role Description

As a member of the Outreach Quality Assurance, Quality Control (QA/QC) team, the Quality Assurance, Quality Control Specialist is involved in one or more areas of Outreach requirements, including but not limited to AFMC Outreach and Provider Outreach activities. Responsible for the quality review of inbound and/or outbound telephone and email inquiries of outreach representatives to ensure accurate information is provided professionally, courteously, and consistently.

• Conduct quality reviews of telephone representatives' performance to ensure quality service goals and standards are met.
• Audit representatives' inbound and outbound phone calls and/or correspondence, observing performance, techniques, and application of guidelines and procedures.
• Verify that representatives are providing up-to-date information and communicating effectively to callers.
• Coordinate with department manager or supervisor to ensure appropriate number of audits are performed for each phone representative.
• Evaluate and record the quality and performance during each call.
• Review and verify document records to ensure compliance with organizational policies and laws.
• Provide creative solutions for reviewing data and solving identified problems.
• Summarize findings and recommendations for performance assessments and promotional decisions.
• Provide feedback on application of guidelines and procedures.
• Provide critical data for generating performance reports.
• Identify adverse performance trends and patterns.
• Assist with the development of additional training or policy changes to enhance service productivity.
• Provide coaching, advice, and guidance based on audit findings.
• Mentor newly hired representatives to ensure a smooth transition to daily work.
• Participate in meetings, presentations, or other designated special projects as assigned.
• Maintain a comprehensive working knowledge of policies, procedures, and benefits across all service lines.
• Other duties as assigned.

Qualifications

• Intermediate level computer skills (Excel, Word, PowerPoint, and Outlook).
• Type 50 wpm.
• Exceptional skills in business English and spelling.
• Ability to maintain confidentiality.
• Strong oral and written communication skills.
• Creativity and customer service orientation.
• Ability to meet deadlines and pay attention to detail.
• Flexibility and knowledge of medical terminology.
• Ability to work collaboratively and independently.
• Initiative and professionalism.
• Strong organizational and problem-solving skills.
• Project management skills.
• Ability to read, interpret, and apply laws, rules, and regulations.
• Time management skills.
• Bilingual a plus.

Requirements

• Mobility, reaching, bending, lifting, grasping, ability to read and write.
• Ability to communicate with personnel and remain calm under stress.
• Must be able to lift and transport 25 pounds.
• Ability to work in an office environment with flexibility to work remotely.
• Potential travel throughout the state, with occasional overnight stays.
• Manage the stress of meeting multiple deadlines and handling interruptions.

Education

• Bachelor’s degree in health sciences field, business, or related field.

Experience

• Three (3) years of professional customer service experience, preferably in quality assurance/control.
• Understanding of the Medicaid Guidelines.
• Desirable: Experience in a healthcare setting.

Internet Requirements

• Reliable, high-speed wireless internet service (Wi-Fi).
• An upload speed of at least 2Mbps is required to support softphone functionality.