• Review of calls accepted within the Member Service Department In order to determine overall performance when accepting member and provider calls.
• Monitor side by side live calls with agents and provide appropriate direction for successful call handling.
• Complete an Audit Summary of each call to present a true and accurate representation of the facts
• Provide input into possible opportunities for Training and Development.
• Completes call transcriptions through actively listening of various calls confirming both the appropriateness and effectiveness of the call.
• Update and maintain the Quality Tracker and Trend Tracker to ensure accurate recording of quality scores and Performance Score Cards.
• Collaborate with leaders for performance enhancement of staff.
• Ensure accurate information is presented and scored using the Departments Quality Weights and Definitions
• Assists with queue calls to help maintain established CMS call center metrics.

CUSTOMERSERVICE:

• Responsible for driving the HealthOps culture through values and customer service standards.
• Accountable for outstanding customer service to all external and internal contacts.
• Develops and maintains positive relationships through effective and timely communication.
• Takes initiative and action to respond, resolve and follow up regarding customer service issues with all customers in a timely manner

REQUIRED SKILLS:

• Ability to read and interpret documents and calculate figures and amounts
• Excellent oral and written communication skills including good grammar, voice, diction
• Effective listening skills
• Ability to perform work in an unbiased and analytical manner
• Proficient in MS Office with basic computer and keyboarding skills
• Excellent customer service skills (friendly, courteous, and helpful)

• High school diploma or general education degree (GED) required
• Minimum of one to three years related experience required
• Previous experience in a customer service environment and health insurance preferred
• An equivalent combination of education, training, and experience.