Summary
The Quality Analyst contributes to and maintains high-quality service to internal customers and external parties. Partnering with Customer Care to monitor and audit the quality of customer care services and provide an in-depth analysis of strengths and weaknesses. Partnering with Policy Administration to perform daily audits and interact with Peers and other team members to improve the quality control process.
Key Functions/Responsibilities (include But Not Limited To)
- Evaluate communications between Customer Care Representatives and customers to ensure quality and adherence to policies and procedures.
- Use call evaluation and audit results to identify common gaps/trends and provide recommendations on how to close gaps. Identify potential performance risks.
- Coaches and provides ongoing feedback to Customer Care and Policy Administration based on trends and quality findings.
- Occasionally lead call calibration sessions for the Customer Care Managers and/or external clients to help ensure consistency and validation of audit parameters, KPIs, and requirements.
- Track the performance of individuals and teams using a data-centric approach.
- Conducts one-on-one coaching for performance improvement.
- Perform daily quality review audits for the Policy Administration teams to remain in compliance with the SSAE audit, to minimize the error ratio and identify performance improvement gaps.
- Collaborate with the broader organization to test and affirm controls and certify remediation or corrective actions plans.
- Ability to keep proprietary information confidential around employee and team performance.
- Act as Training Aid, a fill-in for the training team, as needed.
- Drive a culture of continuous improvement, new approaches, and personal excellence.
- Create and distribute monthly QA/Training newsletter.
Skills & Proficiencies
- Knowledge of Customer Care and Policy Administration process and controls.
- Outcome orientation with a commitment to achieving personal, client, and company goals.
- Strong communication skills – listening, verbal, written.
- Must be able to work collaboratively and cooperatively as a team member.
- Highly organized, detail-oriented, and self-directed with the ability to work independently and in team settings.
- Sense of urgency, highly responsive with a sense of ownership and sound decision-making.
- Understand the need to think broadly to achieve the best possible outcome if/when faced with unfamiliar challenges.
- Ability to use critical thinking skills to look for patterns that are non-compliant to quality standards.
- Self-motivation requires the ability to balance multiple priorities and function in a complex, rapidly changing environment.
- Proficient in Microsoft Office products with an emphasis on Excel, Word, and PowerPoint.
- Commitment to maintaining compliance standards including HIPAA, Anti-Fraud, Cyber Security, etc.
Education & Experience
- BA or BS college diploma in Business Administration, preferred.
- Years of relevant experience: In Quality Control, Quality Assurance, Auditing, and Data Analytics or equivalent combination of education and experience.
- 3 years of exposure in various departments in a health insurance organization such as: customer service, and/or enrollment, claims and premium billing experience or equivalent experience is required.
Certificates, Licenses, Registrations
- Quality Assurance or Training certification preferred or open to achieve
- Life and Health license, preferred
