QA Associate | Claims Associate

Performs and documents results of all quality assurance evaluations on all operational products and services, including (but not limited to) benefit verification cases, patient assistance cases, software support calls/emails, inbound calls from patients or health care providers, data entry, etc. The Operations Quality Assurance Associate I will be a subject matter expert for their respective assigned business unit(s) and will utilize analytical skills to analyze data, processes, and workflows to provide insightful, actionable coaching for the Operations Agents.

Job Title: QA Associate | Claims Associate
Job Location: Pittsburgh, PA 15275 (Hybrid)
Job Duration:6 Months (Possibilities of Extension)
Shift: Mon - Fri, 8:30AM – 5:00PM

Description:

• The Operations Quality Assurance Associate I will evaluate work completed by Operations agents aProductst program SOPs, WINs, business rules, and other program-related documents for adherence to expectations outlined in the documents.
• The QA Associate I must be able to use objective decision-making and critical thinking skills to determine whether audited work meets internal and external expectations.
• The Operations Quality Assurance Associate I will be a subject matter expert for their respective assigned business unit(s) and will utilize analytical skills to analyze data, processes, and workflows to provide insightful, actionable coaching for the Operations Agents.

 
What you will do:

• Coach Operations agents (peer to peer) on areas of opportunity for improvement found during evaluations, collaborate with training for Operations agents (i.e., new hire, refresher, and nesting training).
• Performs and documents results of all quality assurance evaluations on all operational products and services, including (but not limited to) benefit verification cases, patient assistance cases, software support calls/emails, inbound calls from patients or health care providers, data entry, etc.
• Participates in internal, vendor, or client calibration meetings as required to address quality initiatives but does not lead them.
• Identifies and escalates critical quality issues appropriately to senior management.
• Assists with other QA-related functions and responsibilities as needed to meet department and company goals.
• Availability to work occasional evening and/or weekend hours to meet company and departmental goals as the business need arises.
• Auditing work completed by Operations agents.
• Sending feedback to Operations leadership on agent performance.
• Attending meetings, helping with data analysis, and other duties as assigned

 
Skills:
What we need from you:

• Highschool or relevant experience
• 1 – 3 years as a Case Manager, Benefit Verification Specialist, or Contact Center agent or equivalent experience in a similar role in another company, or 1 – 3 years of prior quality control experience.
• Moderate Excel ability (data validation, data entry, tables, simple formulas) Experience with technical writing (e.g., SOPs, User Manuals, Work Instructions), typing, and PowerPoint ability.
• Knowledge Solid working knowledge of quality-orientated services such as accuracy management, performance metrics, customer experience/satisfaction, healthcare benefits, and SOP execution. Health Care Experience is required, specifically claim processing, contact center, benefit verification, or similar industry experience. Call Center and/or Claim Processing experience is a plus.
• Problem-solving, results-oriented, active listening, and high attention to detail. Monitor telephone calls and communications between The Customer and The Customer Care Center. A strong understanding of empathy across the Customer Care Center is required in all patient interactions.
• Ensure provision of exceptional customer service required in customer care case management engagement. Work in a matrix environment requiring strong collaboration skills.