Job Description Summary
This position reports to the Senior Supervisor of Customer Service and performs in-depth audits of customer service calls and administration staff to ensure adherence to set standards and goals. The Customer Service Auditor plans, coordinates, and conducts audits. The incumbent provides each Customer Service Representative with written documentation of each call and compiles a comprehensive report at the end of each month that details the quality results of the team as a whole.
Duties And Responsibilities
Auditing
- Conduct audits of live and 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.
- Strive to exceed audit productivity standards by becoming a product subject matter expert.
- 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.
- Identify inefficiencies within the established processes and suggest possible solutions to save time, reduce risk, and/or reduce expenses.
- Create and document Standard Operating Procedures (SOPs). Identify, initiate, and implement at least one process improvement and/or innovation annually.
Call Center Support
- Assist phone representatives with Customer Service calls during peak periods and as assigned.
- Assist Customer Service Supervisor with training and development by reporting quality error trends.
- Work collaboratively with other areas of WGAT claims and operations to ensure an optimal call center experience at all times.
- Foster and build working relationships with management as well as giving productive feedback to representatives through audits.
- Display professionalism, knowledge and discretion in all interactions.
Other
- 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, be self-accountable, create a positive impact, and be diligent in delivering results.
- Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet.
- Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA-required protection of all confidential/protected client data.
- Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit).
- All other duties as assigned.
Physical Demands/Work Environment
The physical demands and work environment described here represent those that an employee must meet to successfully perform this job's essential functions. 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.
Qualifications
- BA /BS degree in business, health care, or related field and/or three (3) to (5) five years' work experience in the health benefits industry and three (3) experience in a call center measuring, evaluating, and grading calls for those who come into direct contact with customers preferred.
- Exceptional understanding and interpretation of summary plan descriptions of medical/dental benefits.
- Ability to prepare and verbally communicate clear, concise written narratives, memoranda, and audit reports.
- Intermediate computer experience with Microsoft Office and the ability to develop a strong proficiency working with a proprietary Health Care system.
- Strong aptitude for establishing priorities, multi-tasking, working under pressure and deadlines, working independently with minimal supervision or in team environment.
- Ability to work cooperatively with colleagues, team members, employer groups, and members.
- Able to perform in-depth research and analysis on eligibility discrepancies and provide detailed documentation of the issue and recommendations for resulting actions.
- Excellent written and verbal communication skills.
- Working knowledge and comprehension of medical terms and medical claims.
- Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds.
- Home router with wired Ethernet (wireless connections and hotspots are not permitted).
- A designated room for your office or steps taken to protect company information (e.g., facing computer towards wall, etc.)
- A functioning smoke detector, fire extinguisher, and first aid kit on site.