QA \ UR \ Case Management Jobs


Claims Quality Assurance Intermediate Downey, CA


Monitors and coaches the Customer Service Call Center to deliver high quality phone service. Works with team managers to define and implement continuous service quality improvement. Analyzes and provides concise reports regarding quality and productivity issues. Ensures timely intervention into the service quality issues in order to enhance member satisfaction and member recruitment/retention.

Essential Functions:
- Monitors and coaches Customer Service Representatives and team members and promotes all Call Center customer service issues.
- Monitors Customer Service Representatives' delivery of quality phone service to ensure high service standards are maintained.
- Provides ongoing feedback to Team Managers and coaches/counsels Customer Service Representatives to achieve continuous service quality improvement.
- Analyzes data and provides clear, concise reports to the Call Center Management Team regarding quality and productivity issues related to Customer Service Representatives.
- Improves Call Center service quality through recommendations to the Quality Assurance Manager regarding changes in processes and enhancements.
- Ensures timely intervention into service quality issues in order to enhance member satisfaction, member recruitment/retention.


Basic Qualifications:
- Minimum three (3) years of experience in a customer service or health care related field required.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- N/A

Additional Requirements:
- Knowledge of mainframe and/or Personal Computer database, word processing and statistical analysis software packages.
- Must be able to work in a Labor/Management Partnership environment.

Preferred Qualifications:
- Minimum two (2) years of medical claims experience preferred
- Minimum two (2) years of experience in total quality management or productivity analysis preferred.
- Bachelor's degree preferred, OR four (4) years of experience in a directly related field.

Primary Location: California,Downey,Downey Administration Offices 12200 Bellflower Blv

Scheduled Hours (1-40): 40

Shift: Day

Working Days: Mon - Fri

Schedule: Full-time

Job Type: Standard

Employee Status: Regular

Employee Group: Non-Union, Non-Exempt

Job Level: Entry Level

Job: QA / UR / Case Management

Public Department Name: Claims Quality Assurance

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.

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