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Quality Assurance Specialist

2 months ago

Pittsburgh, Pennsylvania, United States PSKW LLC dba ConnectiveRx LLC Full time
Job Title: Quality Assurance Specialist

Overview

The Quality Assurance Specialist will evaluate work completed by Operations agents against program SOPs, WINs, business rules, and other program-related documents for adherence to expectations outlined in the documents.

The Quality Assurance Specialist must be able to use objective decision-making and critical thinking skills to determine whether audited work meets internal and external expectations.

The Quality Assurance Specialist will be a subject matter expert for their respective assigned business unit(s) and will utilize analytical skills to analyze data, processes, and workflows to provide insightful, actionable coaching for the Operations Agents.

Responsibilities
  • Coach Operations agents (peer to peer) on areas of opportunity for improvement found during evaluations, collaborate with training for Operations agents (i.e., new hire, refresher, and nesting training)
  • Performs and documents results of all quality assurance evaluations on all operational products and services, including (but not limited to) benefit verification cases, patient assistance cases, software support calls/emails, inbound calls from patients or health care providers, data entry, etc.
  • Participates in internal, vendor, or client calibration meetings as required to address quality initiatives but does not lead them
  • Identifies and escalates critical quality issues appropriately to senior management
  • Assists with other QA-related functions and responsibilities as needed to meet department and company goals
  • Availability to work occasional evening and/or weekend hours to meet company and departmental goals as the business need arises
Qualifications
  • High school or relevant experience
  • 1 – 3 years as a Case Manager, Benefit Verification Specialist, or Contact Center agent at ConnectiveRx, or equivalent experience in a similar role in another company, or 1 – 3 years of prior quality control experience
  • Moderate Excel ability (data validation, data entry, tables, simple formulas)
  • Experience with technical writing (e.g., SOPs, User Manuals, Work Instructions), typing, and PowerPoint ability
  • Solid working knowledge of quality-orientated services such as accuracy management, performance metrics, customer experience/satisfaction, healthcare benefits, and SOP execution
  • Health Care Experience is required, specifically claim processing, contact center, benefit verification, or similar industry experience

What we need from you:

A strong understanding of empathy across the Customer Care Center is required in all patient interactions. Ensure provision of exceptional customer service required in customer care case management engagement. Work in a matrix environment requiring strong collaboration skills.