Sign upLog in

QA Associate | Claims Associate

Integrated Resources, Inc

Pittsburgh, PA

Apply
JOB DETAILS
SKILLS
Analysis Skills, Calibration, Call Centers, Call Monitoring, Case Management, Claims Processing, Coaching, Compensation and Benefits, Customer Experience, Customer Satisfaction, Customer Support/Service, Data Analysis, Data Entry, Detail Oriented, External Audit, Health Plan, Healthcare, Healthcare Providers, Internal Audit, Leadership, Operational Audit, Patient Care, Performance Metrics, Problem Solving Skills, Process Analysis, Product Programs, Quality Assurance, Quality Control, Software Administration, Standard Operating Procedures (SOP)
LOCATION
Pittsburgh, PA
POSTED
9 days ago
Job Title: QA Associate | Claims Associate
Job Location: Pittsburgh, PA 15275
Job Duration:6 Months (Possibilities of Extension)
Shift: Monday - Friday, 8:00AM - 4:30PM
 
Job Description:
 
Position Summary:
  • The Operations Quality Assurance Associate will evaluate work completed by Operations agents a Products 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.
Day-to-Day Responsibilities:
  • 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
  • Sending feedback to Operations leadership on agent performance
  • Attending meetings, helping with data analysis, and other duties as assigned
Required:
  • 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
  • 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.
#sczr2

About the Company

I

Integrated Resources, Inc

Resume Resources

Free Resume TemplatesFree Resume Builder