1+ months

Call Quality Professional 1 - Doral, FL

Humana
Doral, FL 33166
Description The Call Quality Professional 1 monitors and evaluates the quality of inbound and/or outbound customer service calls. Documents quality issues and performance measures. The Call Quality Professional 1 work assignments are often straightforward and of moderate complexity. Reviews documentation to assess that appropriate system entries have been thoroughly completed to mitigate risk associated with external audit reviews.Responsible for driving accuracy and quality assurance, compliance to all established policies and procedures, and sound documentation for all activities. Serve as a subject matter expert and make process recommendations. Responsibilities The Call Quality Professional 1 provides information to assist in the feedback and formal education process of individuals on the phone. May assist in the development of monitoring standards. May act as subject matter expert. Understands own work area professional concepts/standards, regulations, strategies and operating standards. Makes decisions regarding own work approach/priorities, and follows direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation. Required Qualifications + HS Diploma + Healthcare experience required + Auditing experience required + Ability to handle multiple tasks and deadlines with strong attention to detail + Ability to analyze and proofread data + Research and analysis experience required + Ability to challenge incomplete or inappropriate case research and/or resolutions on grievances/ appeals + Ability to track and trend data and use findings to make recommendations + Excellent communication skills (both oral and written) + Proficiency in MS Office to include Excel, Word and Outlook Preferred Qualifications + Medicare/Medicaid Grievance & Appeals experience + Bachelors degree + Bilingual English/Spanish with ability to speak read and write in both languages without limitations or assistance Relationship + Reports to a Quality Supervisor Additional Information + Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government. Scheduled Weekly Hours 40 About Us Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms when and where they need it. Our employees are at the heart of making this happen and thats why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first. Equal Opportunity Employer It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster. If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact mailbox_tas_recruit@humana.com for assistance. Humana Safety and Security Humana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact mailbox_tas_recruit@humana.com to validate the request. <>

Categories

Posted: 2019-12-06 Expires: 2020-02-09

Before you go...

Our free job seeker tools include alerts for new jobs, saving your favorites, optimized job matching, and more! Just enter your email below.

Share this job:

Call Quality Professional 1 - Doral, FL

Humana
Doral, FL 33166

Join us to start saving your Favorite Jobs!

Sign In Create Account
Powered ByCareerCast