Customer Service Quality Analyst

4 weeks ago

Troy, United States Henry Ford Health System Full time

General Summary: Monitor and assess processes and workflows to insure staff maintains both quality and production measures. To provide ongoing reporting and feedback to both Customer Service Specialist and management staff regarding performance. Measure and implement effort to maintain or increase the quality of work performed within Customer Service. Conduct random audits and quality checks to ensure member inquiries are handled professionally and processed in an appropriate manner. Coordinate and facilitate calibration sessions. Facilitate training for new hires and current staff regarding the audit process and departmental quality expectations. Principal Duties and Responsibilities: Perform call monitoring (recorded and live) to ensure Customer Service specialists are in compliance with the rules and regulations of the organization as well as with NCQA and CMS requirements. Provide coaching, just-in time feedback, and oversight for employees based upon individual performance needs identified through quality audit trends and data collection. Evaluate and monitor new staff while in training , assisting specialists with handling calls in the most effective and efficient manner while ensuring the level of customer service is not negatively impacted. Provide feedback regarding staff and process performance using both survey and technology to increase service levels. Report outcomes to leadership on an ongoing basis. Develop and implement additional programs using technology to support those efforts. Randomly monitor mystery shop inquiries (both written and verbal), review PEGA cases and report feedback to leadership and specialist regarding individual, sectional and departmental performance. Act as a liaison between support departments and Training Consultants regarding performance related issues, keeping open communication to identify additional support needs. Review processes used within Customer Service to identify systemic issues and partner with process owners to improve service. Participate in continuous improvement workshops and other forums aligned with quality assurance and improvement. Utilize quality monitoring system to compile and track performance at team and individual level. Review and assess all performance reporting data and identify gaps in required reporting. Prepare and analyze internal and external quality reports for leadership review. Identify best in class service providers and routinely report on industry trends in service. Identify measures needed to increase overall performance. Audit cases and inquiries to ensure NCQA standards for services are being met across product line. Coordinate and facilitate calibration sessions for call center and vendor leadership. Perform other related duties as assigned. Education Required: Associate’s Degree with a major in Business Administration or related field. Related and relevant experience may be considered in lieu of academic requirements. Related experience is defined as eight (8) years’ experience in a call center with a minimum of two (2) years as a lead worker within an insurance, healthcare or government regulated industry Experience Required: A minimum of two (2) years’ experience in call center customer service. A minimum of one (1) year experience conducting quality audits. Experience providing coaching, feedback, and facilitating training. Experience implementing process change, data analysis, and trend reporting. Experience in research and quality improvement. Skills and Abilities: Excellent documentation skills. Excellent verbal and written communication skills. Self-directed and self-motivated. Strong interpersonal skills and discretion. Organizational and time management skills. Problem solving and decision making ability. Strong understanding of HAP's health care delivery system. Knowledge of HAP's benefits, riders, etc. Understanding of the functions of support departments requiring frequent interaction with Client Services. Strong understanding of the processes used with Client Services. Coaching and counseling. Organization and planning. Leadership and management. Quality improvement. Additional Information Organization: HAP (Health Alliance Plan) Department: CORRESPONDENCE Shift: Day Job Union Code: Office/Non-Exempt, HAP Additional Details This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above. Overview Partnering with nearly 2 million people on their health journey, Henry Ford Health provides a full continuum of services at 250 care locations throughout southeast and south central Michigan. With 33,000 valued team members, Henry Ford is also among Michigan’s largest and most diverse employers. Our superior care and discoveries are powered by nearly 6,000 physicians, researchers and advanced practice providers. Learn more athenryford.com. Benefits Whether it's offering a new medical option, helping you make healthier lifestyle choices or making the employee enrollment selection experience easier, it's all about choice. Henry Ford Health has a new approach for its employee benefits program - My Choice Rewards. My Choice Rewards is a program as diverse as the people it serves. There are dozens of options for all of our employees including compensation, benefits, work/life balance and learning - options that enhance your career and add value to your personal life. As an employee you are provided access to Retirement Programs, an Employee Assistance Program (Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness, and a whole host of other benefits and services. Employee's classified as contingent status are not eligible for benefits. Equal Employment Opportunity/Affirmative Action Employer Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health is committed to the hiring, advancement and fair treatment of all individuals without regard to race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height, weight, marital status, family status, gender identity, sexual orientation, and genetic information, or any other protected status in accordance with applicable federal and state laws.

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