Operations Quality Auditor

  • location: Tampa, FL
  • type: Contract
  • salary: $15 per hour
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job description

Operations Quality Auditor

job summary:
JOB SUMMARY

  • Perform compliance quality audits on all Inbound and Outbound teams including teams with Casework in Operations.
  • Assist in the development of QA strategies on policies, procedures and systems to accurately measure and report areas of improvement.
  • Manage turn-around times to ensure compliant with business requirements.
  • Participate in any internal compliance or external CMS audit or state audit.
  • Assist in the development of trending issues.
  • Recommend training improvement changes.
  • Perform random Shopper Test Calls and Root Cause Analysis on Operational areas to ensure accuracy of departmental processes and identify ,when needed. process improvement opportunities.
ESSENTIAL FUNCTIONS ---- Note: The following is not intended to be an exhaustive list of all duties required of this position ---- Key Duties and Responsibilities

  • To review telephone calls in accordance with Client's quality policy
  • Review casework (CTM. Grievance) and call documentation for thoroughness and accuracy of information while meeting compliance turn-around-times in accordance with Client Policy and Procedure and any government (Federal or State) processes
  • Summarize and communicate to management audit results on a regular schedule
  • Assist with team training and attend calibration
  • Identify trends prioritize and recommend improvement in documentation and call handling.
  • Assist in review of all CMS audits,internal or external state audits.
  • Identify training opportunities, individual and team coaching needs and reports findings to senior management.
  • Develop and present ideas for performance and process improvement within the department
  • Acts as subject matter expert (SME)
  • Assist with other projects and duties as assigned
  • Additional Position Responsibilities - Optional
MINIMUM QUALIFICATIONS ---- Education ---- State the minimum required for the job ---- Education Level Education Details Required/Preferred

  • A High School or GED Required
  • A Bachelor's Degree in a related field Preferred
Work Experience ---- State the minimum required for the job ---- Experience Level Experience Details Required/Preferred

  • 2+ years of experience in Customer Service Required
  • 5+ years of experience in directly related work Required
Licenses and Certifications ---- List professional licenses and certifications associated with this job ---- Licenses/Certifications Other Licenses/Certifications Required/Preferred

Skills ---- State the minimum required for the job ---- Skill Sets Other Skills Proficiency

  • Ability to multi-task Intermediate
  • Ability to work in a fast paced environment with changing priorities Intermediate
  • Other Ability to remain calm under pressure Intermediate
  • Other Ability to sit for extended periods of time Intermediate
  • Other Demonstrated technical expertise in performing quality reviews along with analysis of results Intermediate
Technology ---- List technical skills associated with the job ---- Technology Other Technology Proficiency Required/Preferred

  • Microsoft Outlook Intermediate Required
  • Microsoft Word Intermediate Required
  • Microsoft Excel Intermediate Required
  • Microsoft PowerPoint Intermediate Required
  • Other Knowledge of additional software programs as necessary Intermediate Required
Languages ---- List all that apply ---- Languages Other Languages Required/Preferred

Grievance, CTM case work and/or quality auditing (in healthcare) experience Also, these positions are being opened to support additional membership we are expecting in January 2020 for Aetna. It is a possibility that these positions may only last 30 -60 days, or turn into a permanent position. We will know more after January when temp is hired.

 
location: Tampa, Florida
job type: Contract
work hours: 8 to 5
education: High School
experience: 5 Years
 
responsibilities:
ESSENTIAL FUNCTIONS ---- Note: The following is not intended to be an exhaustive list of all duties required of this position ---- Key Duties and Responsibilities

  • To review telephone calls in accordance with Client's quality policy
  • Review casework (CTM. Grievance) and call documentation for thoroughness and accuracy of information while meeting compliance turn-around-times in accordance with Client Policy and Procedure and any government (Federal or State) processes
  • Summarize and communicate to management audit results on a regular schedule
  • Assist with team training and attend calibration
  • Identify trends prioritize and recommend improvement in documentation and call handling.
  • Assist in review of all CMS audits,internal or external state audits.
  • Identify training opportunities, individual and team coaching needs and reports findings to senior management.
  • Develop and present ideas for performance and process improvement within the department
  • Acts as subject matter expert (SME)
  • Assist with other projects and duties as assigned
  • Additional Position Responsibilities - Optional
 
qualifications:
MINIMUM QUALIFICATIONS ---- Education ---- State the minimum required for the job ---- Education Level Education Details Required/Preferred

  • A High School or GED Required
  • A Bachelor's Degree in a related field Preferred
Work Experience ---- State the minimum required for the job ---- Experience Level Experience Details Required/Preferred

  • 2+ years of experience in Customer Service Required
  • 5+ years of experience in directly related work Required
Licenses and Certifications ---- List professional licenses and certifications associated with this job ---- Licenses/Certifications Other Licenses/Certifications Required/Preferred

Skills ---- State the minimum required for the job ---- Skill Sets Other Skills Proficiency

  • Ability to multi-task Intermediate
  • Ability to work in a fast paced environment with changing priorities Intermediate
  • Other Ability to remain calm under pressure Intermediate
  • Other Ability to sit for extended periods of time Intermediate
  • Other Demonstrated technical expertise in performing quality reviews along with analysis of results Intermediate
Technology ---- List technical skills associated with the job ---- Technology Other Technology Proficiency Required/Preferred

  • Microsoft Outlook Intermediate Required
  • Microsoft Word Intermediate Required
  • Microsoft Excel Intermediate Required
  • Microsoft PowerPoint Intermediate Required
  • Other Knowledge of additional software programs as necessary Intermediate Required
 
skills: Other
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

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