Call Quality Professional 1

Profile

Job Information

Humana

Call Quality Professional 1

in

Lancaster

South Carolina

Description

The Call Quality Professional 1 monitors and evaluates the quality of inbound and/or outbound customer service calls, call documentation and processes. Responsible for identifying and documenting gaps as well as recommending business solutions to drive improved quality and performance outcomes. The Call Quality Professional 1 work assignments are often straightforward and of moderate to high complexity. Evaluates call recordings and documentation to assess appropriate process adherence in order to mitigate compliance and patient safety risks 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 to drive project improvement and serve as an associate advocate by supporting their content knowledge and sharing call management best practices.

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 and updating of monitoring standards based on the business needs. Understands own work area professional concepts/standards, regulations, strategies and operating standards. Responsible for supporting a forward thinking and professional culture within the organization. Makes decisions regarding own work approach/priorities, and periodically communicates progress. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation and self-initiation.

Required Qualifications

HS Diploma or equivalent

Experience working within a Healthcare environment and/or Quality Assurance.

Excellent verbal and written communication skills.

Documentation and call auditing experience to identify process improvement to promote efficiency in meeting compliance measures.

Ability to handle multiple tasks and deadlines within short notice with strong attention to detail

Ability to research, analyze and proofread data

Ability to interpret documentation and guidelines with complexed or limited details

Intermediate proficiency with MS Office: Excel - create spread sheets, Word, and Outlook

Ability to challenge incomplete or inappropriate case research and/or resolutions Ability to track and trend data and transform findings into business solutions

WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications

Associate's degree or higher

Medicare/Medicaid experience

Intermediate proficiency with MS Office PowerPoint and Vizio

Fully Bilingual English/Spanish. Must be able to speak, read and write in both languages without limitations or assistance. If selected for the position, you will be required to take a Language Proficiency Assessment in English/Spanish. See Additional Information on testing

Additional information

Schedule:

Monday to Friday from 8 am to 8 pm. Schedule is subject to change based on business needs (Voluntary/Mandatory OT - Including Weekends)

Training:

Remotely due to COVID-19 emergency

External Candidates

: New Hire Training

6 - 8 weeks in Class Training

5 - 6 weeks on the Job Training (taking calls)

Role Training

- 4 weeks (Practice/Quality)

Internal Candidates

(Member Service area): Straight to Role Training

External Candidates:

Role Training will start once the 10 weeks of New Hire Training is completed

Work Location (Address): This permanent job is working from Home

​Travel: 30%

(FOR BILINGUAL CANDIDATES ONLY) Language Proficiency Testing:

Any Humana associate who speaks with a member in a language other than Spanish and/or 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. Excellent communication skills (both oral and written).

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com