Call Center Assurance Auditor
JOB DESCRIPTION SUMMARY
Position reports to Supervisor of SHOP Customer Service and is responsible for supporting total quality methods, processes and procedures for the Call Center. This position helps preserve service excellence through: monitoring and assessing customer service interactions of Call Center Representatives; documenting representative's performance strengths and weaknesses; highlighting immediate compliance issues; assisting in generating standard process measurement reporting; and developing quality guidelines and procedural manuals. The Quality Auditor will serve as a contributor to the coaching, support, training and daily operation of the call center. The incumbent will ensure that the practice's quality, compliance, and workflow guidelines are met
through call interactions within the monitoring system.
• High school education or equivalent and/or three to five years’ work experience in the health benefits
• Previous experience with progressive Quality Assurance/Auditing, call center/customer service
experience measuring, evaluating, and grading customer service calls in a healthcare environment
• Bilingual in Spanish required.
• In-depth understanding and interpretation of summary plan descriptions of medical/dental benefits.
• Comprehensive knowledge of quality assurance and continuous improvement concepts, procedures
• Excellent technical skills and experience with Word, Excel and Outlook; the ability to develop a strong
proficiency working with a proprietary Health Care system.
• Strong aptitude for establishing priorities, multi-task, work under pressure and deadlines, work
independently with minimal supervision or in a team environment.
• Excellent interpersonal, customer service, analytical problem-solving and decision making skills
• Ability to analyze high-level results, research trends, and determine root cause of performance trends.
• Must have excellent reading, verbal, and written communication skills and ability to interact
professionally, patiently, and courteously with customers over the phone and in person.
• Demonstrated ability to handle difficult calls and benefit issues with little assistance and provide
accurate and thorough information in a fast-paced environment.
• Ability to exercise good judgment, initiative and discretion in confidential and sensitive manners and
project a professional business presence and appearance.
DUTIES AND RESPONSIBILITIES
• Conduct real-time "live" audits reviews and provide real-time guidance to call center employees.
• Conduct audits on recorded phone calls in order to measure accuracy and timeliness and to ensure the
staff follows the established standards for call quality outlined in the Quality Guidelines.
• Meet and maintain a 2% or lower error ratio month over month, based on accuracy adhering to the
quality guidelines and clear communication through the audit forms received by the representatives.
• Evaluate audit results to identify trends and patterns, pinpoint issues and areas of improvement and
recommend solutions and alternatives.
• Track quality scores, trends, and commitments against established workflows and quality standards
through call audits.
• Conduct comprehensive call quality review to identify performance deficiencies, and provide regular
feedback to leadership regarding call trends or compliance issues that may arise.
• Compile, track and publish reports based on audit results and monitoring of contact types. Distribute
reports weekly, monthly and quarterly basis.
Training & Call Center Support
• Become a subject matter expert in for Covered California, State Provided Programs and their website,
• Collect and analyze quality and call center data and initiates, develop and recommend improvements
to systems, processes and procedures to increase productivity and reduce cost.
• Create written job aides, process documents, and issue resolution material to ensure contractual and
• Create and run standard and ad-hoc reports to monitor contact center performance metrics.
• Participate in corrective/preventive action planning & implementation related to audits.
• Contribute to the development of training curriculum and materials manuals as needed.
• Identify and lead quality improvement initiatives and activities across the team that lead to excellent
call center experiences.
• Assist phone representatives with Customer Service calls during peak periods and as assigned.
• Ability to foster and build working relationships with management as well as giving productive
feedback to representatives through audits.
• Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our
members. Do everything possible to help members succeed by being curious and striving to
understand what others are trying to achieve, planning, and executing work helpfully and
collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others, being
self-accountable, creating a positive impact, and being diligent in delivering results.
• Meet all department service, attendance, and performance metrics.
• All other duties as assigned.
PHYSICAL DEMANDS / WORK ENVIRONMENT
The physical demands and work environment described here are representative of those that must be met by an employee to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to communicate with others. The employee frequently is required to move around the office. The employee is often required to use tools, objects, and controls. This noise level in the work environment is usually moderate.