Quality Auditor II
CHRISTUS System Office
919 Hidden Ridge
Irving, TX 75038
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The primary objective of this position is to audit Customer Service calls for all CHRISTUS product lines, measure and report quality results and identify trends and opportunities for improvement. Customer Service calls are evaluated against established criteria which includes but are not limited to the accuracy of information provided on claims, benefits and eligibility, provider network status, soft skills, and HIPPA.
- Identify prevalent trends and recommend resolution techniques to management.
- Ability to work independently without direct supervision.
- Ensures 10% calls and events are performed per agent, per month.
- Assist with inbound calls during peak call periods, as directed by Department Manager
- Identify additional training needs based on review and analysis of quality monitoring results.
- Share ideas/recommendations for process improvements for monitoring and training with the management team.
- Develop and coordinate the implementation of systems, procedures, and forms to improve data collection.
- Assist in the development of action plans to address quality deficiencies.
- Ability to coach agents in areas of concern by reviewing calls, or system notes, to ensure the agent understands audit results.
- Produce weekly, monthly, quarterly and annual management and operations focused reports in a timely manner.
- Assist in developing and maintaining a dashboard to report Corporate and Client Quality results.
- Identifies and escalates process issues, system defects and errors in instructional material to appropriate team and management
- Ability to organize and prioritize work to meet deadlines
- Strong computer application skills including Microsoft Word, Excel and Visio
- Excellent written and verbal communication skills required
- Good judgment, initiative, and problem-solving abilities
- Ability to handle and resolve complex issues independently
- Knowledge of Medicaid, Medicare Advantage, Tricare and Health Care Exchange programs preferred
- Knowledge of claims processing, provider status, benefits and eligibility
- Ability to learn new policies and processes based on written material and observation
- Ability to establish and maintain professional, positive and effective work relationships
- Prior Customer service experience require
- Experience with claims status, benefits, and eligibility preferred
- Three plus years Customer Service management preferred