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Customer Service Auditor

4 months ago

Westborough, United States Health Plans Inc Full time
Job DescriptionJob Description

Do you envision working for a company that has the expertise of a long-standing industry leader, but the spirit of an entrepreneur? Does the thought of making a real impact motivate and energize you? If so, HPI is the place for you. Join a team that values integrity, flexibility, loyalty, compassion and dedication—we can’t wait to meet you.

What we do

HPI is unique. A respected industry leader that’s been serving customers for over 40 years, we’re known for our innovation and growth. Our experience has given us our expertise, but our forward-thinking, entrepreneurial spirit has given us our strong reputation. As a third-party administrator, we offer a suite of health and benefit solutions to employers. By joining HPI, you’ll contribute to ideas that make a real difference for employers and employees nationwide. There isn’t a challenge we won’t accept and we’re looking for people who have a passion to take it on. Not just a job—a mission.

What you’ll do

The Customer Service Auditor is responsible for the quality review of telephone and email inquires of call center phone representatives to ensure accurate information is provided professionally, courteously and consistently. Also, audits phone conversations for compliance with corporate policies, procedures, and applicable regulatory guidelines. In addition, the Customer Service Auditor is responsible for the review of the accuracy and timeliness of Member Appeals to ensure compliance with plan and regulatory requirements.

In this role, you’ll also:

  • Conduct quality reviews of telephone representatives' performance to ensure quality service goals and standards are met and/or identify areas where improvement can be achieved.
  • Audit representatives' phone calls and/or correspondence, observing performance, techniques, and application of guidelines and procedures.
  • Audit member appeal process from start to finish ensuring compliance with Policy & Procedure and Customer Service Standards.
  • Verify that representatives are providing up-to-date information, following current processes, and communicating effectively to callers.
  • Coordinate with department Seniors, Supervisor and Manager to promote quality coaching.
  • Evaluate the quality and performance of each assigned call.
  • Provide input and assist with the development of additional training or policy and procedure changes that may be required to enhance service productivity.
  • Provide coaching, advice and guidance based on audit findings, and delivers performance feedback as requested by manager.
  • Assist by taking inbound customer calls or handling inbound customer emails, in periods of excessive call volume.
  • Participate in meetings or other designated special projects as assigned by department manager.
  • Maintain a comprehensive working knowledge of polices, procedure, and benefits across all product lines.
  • Be an active participant in team meetings.
  • Follow HIPAA guidelines and other standard office policy and procedures.

What you bring

  • Possess initiative, balanced judgment and objectivity
  • Knowledge of healthcare provider billing procedures
  • Strong interpersonal skills
  • Ability to prioritize and multitask effectively
  • Communicate effectively, both verbally and in writing
  • Work independently and as a member of a team
  • Ability to anticipate and understand systems interactions
  • Must be detailed, analytical and accurate
  • Knowledge of federal, state and NCQA appeals standards
  • Ability to work within specified timeframes and meet deadlines
  • Recognize and maintain confidentiality of work materials as appropriate
  • 2 or more year’s experience in Customer Service or Call Center environment
  • 2 or more year’s experience in healthcare industry preferred
  • Some college preferred
  • Proficiency in Healthware, WebECI, and CSI PAC systems preferred

Why choose us?

  • Our space is a reflection of who we are—innovative, open and collaborative.
  • Love to get creative? We do too. Brainstorm in one of our team break-out rooms.
  • We think feeling your best is an important factor in producing great work, so we embrace a “smart casual” dress code and work at ergonomic desks.
  • Need to reenergize? Take a break to chat in the onsite café, go for a walk on one of the beautiful trails in our office park, or get in a quick workout at one of the campus gyms.
  • We offer our employees incredible health coverage, a 401(k), employer-paid disability, EAP, hybrid work arrangements, and quarterly bonuses.
  • We’re a people-first company and value giving back to our community. Ask us about our volunteer opportunities.

So, think you want to join the HPI team? We hope to hear from you

You can read more about us at hpitpa.com/about-us/careers/

EEO/AA/M/F/Vet/Disability Employer