SCOPE OF ROLE
The Quality Assurance Analyst (Enrollment & Billing) assists and coaches individuals on the MES Team to ensure that all individuals are providing exceptional customer service for our Bright customers.
ROLE RESPONSIBILITIES
The Quality Assurance Analyst (Enrollment & Billing) job description is intended to point out major responsibilities within the role, but it is not limited to these items.
- Utilize knowledge of State-based exchange, Federal Facilitated Marketplace (FFM) and Brighthealth procedures to accurately evaluate telephone, email and contact center interactions for alignment with defined processes and procedures; meets established goals and metrics, as business needs require.
- Provide training and guidance, verbally and in writing, to associates and Supervisors related to areas of opportunity; share best practices.
- Participate in the discovery and resolution of root cause(s) of recurring issues; Isolate, replicate and document defects and suggest alternatives to provide better outcomes.
- Daily, Weekly, and Monthly Reporting.
- Assist with Escalated calls.
- Other duties and responsibilities as assigned.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- High School diploma or GED required.
- Two (2) years experience in a customer service role required
- One (1) year experience in a lead or supervisor role preferred
- One (1) year experience auditing transaction (phone, email, chat, etc) and providing constructive feedback required, preferably in the healthcare and/or in a high-volume contact center environment
- Working knowledge and/or experience working with Individual Family Health Plans (IFP), Federally Facilitated Marketplace (FFM), the Affordable Care Act (ACA), or experience in a related healthcare industry preferred.
- Basic computer skills, inclusive of Microsoft office required.
PROFESSIONAL COMPETENCIES
- Must be detailed oriented and present critical analytical thinking skills
- Must display active listening skills
- Organized and be able to prioritize work to meet deadlines
- Collaborate effectively with internal and external partners to resolve issues for our members.
- Must present strong ability to read and comprehend material presented both orally and in writing
- Strong communication skills, both verbal and written
- Comfortable applying basic math skills
- Works independently with little supervision
- Able to thrive and adapt in a fast paced, stressful environment
- Must be flexible to change and open to learning new tasks as assigned
- Must have intermediate skills using Microsoft Office, along with general computer and typing skills
LICENSURES AND CERTIFICATIONS
Producer licensing for Health & Accident may be required in the state in which an individual resides for OEP 2020 or before an individual will be able to transition into a FTE MES role. (Potential temp to FTE is a minimum of 6 months.)
WORK ENVIRONMENT
The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer. Travel may be required.