CS Quality Assurance Analyst

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The Customer Services Quality Assurance Analyst (QAA) is responsible for assessing the quality of the performance of our call center representative who deal with our existing and potential customer. The QAA will be responsible for ensuring that our Customer Services Representatives are meeting expectations as detailed in the departmental policies and procedures. This individual will assist in developing, creating, and implementing call center quality processes and procedures; as well as making recommendation for enhancements to training materials as needed to enhance the overall MetroPlus Health customer’s experience.

• Conduct audits on all delegated vendors for which Customer Services is responsible.
• Conduct quality assurance for the Grievance and Complaints unit.
• Conducts secret shopper calls to the Call Center to assess the Customer Service Representatives
• Perform second level quality audits (rebuttals) for CSR calls.
• Participate in audit readiness and reviews.
• Contribute to the development and maintenance of customer services policy, procedures, internal desk manuals and workflows.
  • Support use of knowledge management tools, including new workflows, and troubleshoot problems.
• Work with the training team to ensure that all CSR training materials are up to date. Additionally, develop job aids and refreshers, and maintain a library of knowledge management
  to deploy to CSRs as needed.
• Participates in User Acceptance Testing (UAT) for new systems or implementations and provides feedback.
• Identify opportunities for content additions and improvements.
  • Analyze information needs, propose solutions, and follow through on measuring improvement.
  • Propose and implement plans to update information.
• Provide administrative support to extrapolate relevant data and develop awareness for policy updates/changes.
• Utilize QA data to analyze, identify trends and skill gaps, and provide recommendation to management for an optimized customer experience.
• Other duties as assigned by the Director of Call Center Quality and Compliance and/or the Senior Director of the Call Center Operations.

• Bachelor’s degree plus 1 year of related experience OR Associate’s degree with a minimum of 3 years related experience.
• Knowledge of Managed Care is a plus.
• High Proficiency in Excel
• Bilingual is a plus (Spanish, Bengali, Creole, Mandarin, Cantonese, French)
• System Knowledge: NICE, Verint, Calabrio

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Written/Oral Communication

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