Medicare Member Quality Assurance Analyst

Operations Miramar, Florida


Description

Position at Clear Spring Health

Group1001 is a consumer-centric, technology-driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can-do culture. Group1001’s culture emphasizes the importance of collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets – our employees.

Company Overview

Clear Spring Health is part of Group One Thousand One (“Group1001”), a customer-centric insurance group whose mission is to make insurance more useful, intuitive and accessible so that everyone feels empowered to achieve financial security. Clear Spring Health is dedicated to helping seniors protect their health and well-being by providing Medicare Advantage plans in select counties of Colorado, Illinois, North Carolina, and Virginia, plus Georgia and South Carolina through our affiliate, Eon Health (redirects to Eon).

Group1001 is on a mission to empower consumers. Our family of companies share a common goal: giving people more control over their money, making it easier for them to do businesses with us, and creating more opportunities for them to see value every day.

Group1001 is a consumer-centric, technology-driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can-do culture.

One of the goals for Group1001 is to foster a great culture.  Group1001 will continue to build a culture that emphasizes the importance of collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets, employees. 

 

Job Summary

Under the supervision and direction of the Director of Member Services, the Member Services Quality Assurance Facilitator is responsible for evaluating and assessing the accuracy and performance of the onshore and offshore Member Services Representatives to ensure members are receiving high levels of service and the team is meeting service level agreements and standards.

 

Main Accountabilities:

  • In conjunction with the Director assumes responsibility for the implementation of the plan’s member services quality assurance processes.
  • Performs contact monitoring and provide trend data to the account’s internal Management Team.
  • Participates in meetings with Management to inform and discuss individual and team performance.
  • Track quality scores, trends, and program updates using Plan approved tools.
  • Participate in offshore calibration calls and provide feedback.
  • Make recommendation for enhancements to training material, as needed to enhance the overall MSRs quality.
  • Conduct audits and reviews when applicable and submit in a timely basis.
  • Recommend coaching and training of MSR to Member Services management team.
  • Assist with training as assigned by Management.
  • Participate in internal and external Member Services audits.
  • Assists with other duties as assigned

 

Qualifications:

  • A minimum of 3+ Years of Call Center experience required
  • Knowledge of Medicare products and services Demonstrated ability to mentor and coach others, including a strong commitment to customer service and quality required.
  • Strong verbal and written communication skills
  • Proven decision-making skills and ability/willingness to multi-task in a fast-paced environment
  • Strong organizational and time-management skills
  • Ability to multi-task, good organizational and time management skills.
  • Analytical skills in research and problem resolution.
  • Analytical ability with an affinity to detail, as well as the capability to handle heavy workloads and meet deadlines.
  • Must be able to work and act independently and be self-directed.
  • Prior team lead experience, preferred