Consumer Services Quality Assurance Manager

Company Overview:

Join us in our mission to transform healthcare! RxAdvance, now doing business as nirvanaHealth, is committed to bringing the art of possible to the payer and PBM industries, which is why we strive to invest in our employees throughout all stages o f life. Success radiates through all levels of employees here, with competitive benefits, a strong focus on employee wellness, and optional education courses offered through UDEMY: we aim to support all aspects of employee growth.

Characterized by curiosity, innovation, and an entrepreneurial mindset, nirvanaHealth is the first to offer medical and pharmacy benefit management solutions that run on the same platform, made possible by our creation, Aria – the first robotic process automation cloud platform designed for healthcare.

Led by our chairperson John Sculley (former Apple CEO) and noted healthcare entrepreneur and founder of ikaSystems Ravi Ika, nirvanaHealth endeavors to sizably reduce the $900 billion in waste in healthcare administrative and medical costs. We are seeking A-players to join our team – folks who embrace the grind and hustle of a growing company, are collaborative and innovate, are life-long learners and growers, and have an entrepreneurial and positive mindset.

Job Summary:

The Consumer Services Quality Assurance Manager is responsible for monitoring and auditing work performed to ensure the highest quality standards in accordance with company policies and procedures. This individual works closely with the VP of Consumer Services and CS leadership team. The Quality Assurance Manager documents the call quality results and provides feedback and trend data to the Supervisors and VP as required. This role is heavily analytical and requires critical thinking skills. They will display sound judgement, flexibility, strong communication skills to continue to optimize member experience. They will also identify improvements to performance, processes, and training within the Consumer Services Department.

Job Responsibilities (but not limited to):

• Conduct live call monitoring of customer contacts to optimize process, improve representative performance, and identify and report system issues.
• Verify call results by measuring staff’s demonstrated knowledge and skills during calls, and evaluate product and system knowledge, service ability, rapport building and problem solving.
• Grade customer interactions on the scoring method utilized by the department. Provide additional one-on-one coaching with CSRs as needs are identified. Provide notifications of coaching opportunities to VP of Consumer Services & CS Mangers.
• Understand the performance and quality standards expected of Consumer Services employees.
• Provide concrete examples of how you would like the agent to improve in areas of concern.
• Complete audits on time and provide standard monthly reporting with predetermined reporting parameters.
• Evaluate calls from an objective point of view, ensuring that fairness in evaluating calls is the norm.
• Meet daily quota of number of quality reviews per day.
• Participate in the design of call monitoring formats and quality standards. Continually evaluate and develop audit/monitoring procedures to improve efficiency and effectiveness.
• Collaborate with internal teams and clients to ensure Quality metrics and member experience is achieved.
• Identify process improvement opportunities and develop process improvement plans to meet and exceed client expectations.
• Analyze and prepare quality reports identifying trends and areas of improvement and prepare reports for various internal & external meetings.
• Routinely assess departmental policies & procedures to ensure service standards are consistently applied, and to validate the accuracy of internal and external documentation/scripting.
• Assist CS Managers in providing standard monthly reporting with predetermined reporting parameters.
• Develop and conduct regular Voice of Customer / Calibration Sessions to highlight key gaps and improvement opportunities for products and services.
• Routinely perform test calls and mock calls to ensure quality and performance of the representatives.
• Identify and report issues proactively relating to system quality and hardware performance.
• Other duties as assigned.

Qualifications:

Education and/or Training:

• High School Diploma or Equivalent Required
• Bachelor’s Degree is required.
  • Equivalent experience (4 years) in a health plan, PBM, TPA call center environment will be accepted.

Professional Experience:

• Prior contact center experience in a quality assurance role required, a minimum of 2 years’ experience is preferred.
• Experience with call monitoring on inbound and outbound calls and auditing specific to Medicare and Managed Care.
• Experience in Call Center Quality management.
• Listening proactively, Live call monitoring (inbound and outbound).
• Must have Medicare expertise and medical billing experience.
• Past experience of working independently and remaining unbiased.
• Able to work in a high-volume call center environment; previous call center experience is a must.
• Excellent communication, writing, and organizational skills with the ability to multi-task and collaborate in a team.
• Requires critical thinking skills and decisive judgement.
• Experience with providing coaching and feedback preferred.
• Experience with training and content development is a major plus.

Specialized Skills:

• Must be able to work independently in a fast-paced/multi-tasked environment.
• Exceptional listening skills.
• Strong analytical, reporting and problem-solving skills.
• Strong interpersonal, time management, and organizational skills.
• Proficient PC skills; MS Word, Excel, Access, and Power Point (particularly Excel preferred).

Additional Considerations:

Applicants must be able to pass a background investigation as all offers are pending a successful completion of background check per the company policy.