Quality Assurance Specialist Non-Clinical (Bilingual Spanish) - Remote

Under the direction of the Enrollment Assistance Manager, the Quality Assurance Specialist is responsible for ensuring that all regulatory requirements and IEHP Customer Service requirements pertaining to Quality Assurance pertaining to enrollment of Prospective Members into IEHP Covered CA and Medi-Cal.  The Quality Assurance Specialist will utilize quality auditing tools to support the Sales and Outreach unit in identifying training needs, as well as develop appropriate new and ongoing training utilizing classroom and e-learning training environments. In this role, the Quality Assurance Specialist will assist in the design, structure, and facilitation of the Sales and Outreach training curriculum, in alliance with organizational core values.

This is a Bilingual (English/Spanish) position. The Team Member in this role must take a language proficiency assessment and must receive a passing score.

1. Strive to live and practice IEHP’s Mission, Vision and Values (MVV) every day, and strongly commit to advance the organization’s strategic plan.  
2. Assist in the development, implementation and evaluation of Strategy training modules that include, but is not limited to the following:
    a. Classroom training program
    b. Hands-on training program
    c. Small group training
    d. E-learning (Computer Based Training) curriculum 
    e. Training during scheduled and ad hoc department meetings
    f. One-on-one training
3. Will perform ongoing Quality Assurance of Enrollment Assistance by reviewing team member’s live and recorded telephone calls to ensure all regulatory and programmatic requirements are met, to manage customer service, job knowledge, quality, and apply appropriate and consistent applications of business rules.
4. Assist in the preparation and analysis of reports for the purpose of tracking and trending Strategy Staff performance and identifying opportunities for improvement. Review and report audit findings to the Enrollment Assistance Manager and Staff to support requirements of accuracy and productivity.
5. Provide analytical support to the Strategy team and leadership in the development and maintenance of training programs for new team members and existing team members. Based on performance metrics, identify team member deficiencies, and formulate course improvement work plans in concert with management objectives.
6. Assist in developing the overall plan and structure for training programs, as well as develop and enhance the training materials, which include e-learning, manuals, course outlines, background materials, workbooks, handouts and course assessments.
7. Assist in the development and maintenance of tools necessary to assist Strategy in daily work activities to ensure department processes are structured and are followed appropriately.
    a. Ex:  Department job aids, resource tools, flowcharts, policies & procedures, etc.…
8. Assist in researching effective training delivery, including but not limited to traditional e-learning, classroom training, group workshops, and self-paced and one-on-one sessions. 
9. Excellent interpersonal/communication skills, problem solving capabilities, ability to establish and maintain effective working relationships, trustworthy, reliable and an independent worker.
10. Develop a complete understanding of the Strategy call center processes, resources, training programs and Quality Assurance programs.
11. Assist Strategy leadership, as requested.

Bilingual (English/Spanish) - written and verbal skills required

Two (2) or more years of quality monitoring in a health care delivery setting.

Quality monitoring experience with an emphasis on training development preferred. Experience in an HMO or in a Managed Care plan such as Medi-Cal and Covered California Marketplace Exchange setting is preferred.

High School Diploma or GED required.

Bachelor’s degree from an accredited institution preferred.

Covered California Plan Based Enroller Certification preferred.

Possession of an active, unrestricted, and unencumbered California Life Agent and Accident and Health or Sickness license issued by the California Department of Insurance preferred.

Knowledge of Covered California Guidelines, Title 22, Title 10, and DHCS regulatory requirements. Health plan call center operations preferred. Understanding of and sensitivity to a multi-cultural environment and community.

Excellent writing interpersonal, communication, project management and organizational skills. Strong computer skills in Microsoft Word, Power Point and Excel. Knowledge of Microsoft Access preferred.

Must have a high degree of patience and attention to detail.

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

While performing the duties of this job, the employee is occasionally required to stand, walk, sit, balance, stoop, kneel, and crouch. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include: close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.  Word processing and data entry involving computer keyboard and screens.

Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval. All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership.