Customer Experience Quality Control Trainer (QCT) - Care N' Care Health Plan - Southwestern Health Resources (SWHR)

Here’s What You Need

Education

• High School Diploma or equivalent required.

Experience

• Require 2 years’ experience in Customer Service, Sales, Account Management, Quality Monitoring or Training experience.
• Require 1 year experience in Managed Care, Health Plan Operations, or Medicare.

Skills & Abilities

• Thorough knowledge of CMS guidelines, process and systems.
• Excellent problem solving and organizational skills.
• Strong interpersonal communication skills.
• Ability to work independently or as a team.
• Excellent knowledge of Microsoft Office (Excel, Word, PowerPoint).

What You Will Do

Position Responsibilities

Customer Experience Quality Control Trainer (QCT) is responsible for on boarding and deploying new staff of the Customer Experience Team as well as ongoing training and coaching as necessary or as regulatory guidelines are changed. By completing regular quality control monitoring activities of the team, the Quality Control Trainer will identify and report trending matters for training and process improvement as well as document processes for training purposes and service success of the Customer Experience Team.

Position Functions

• Must maintain a strong understanding of all Customer Experience team processes and procedures and identify and report trends in gaps by call monitoring evaluations and satisfaction.
• Responsible for suggesting and assisting with implementing methods to improve efficiency and service to both internal and external customers and may participate in process and training documentation development.
• Meets weekly with team leadership offering suggestions for gaps identified within call monitoring and evaluations. Communicating successes and areas for strengthening service and resolution for member population, prospective members, agents and healthcare provider experience.
• Provide training to staff for member population, prospective members, agents and healthcare provider education and counseling on access to services, benefits and providers recognizing areas for strengthening customer service and accuracy through team interaction and positive motivational methods.
• Assume ownership and responsibility for member population, prospective members, agents and healthcare provider satisfaction with Care N' Care by identifying and implementing efficient training methodology and streamlined processes for improvement.
• Assistance with daily tasks as necessary for maximum performance of business operations including answer incoming phone calls from active member population, prospective members, agents and healthcare providers (i.e. physician offices, clinics) and identify the type of assistance the caller needs (i.e. benefit and eligibility, claims, billing and enrollments, prior authorization status, pharmacy inquiries, etc.) Maintain personal metrics to established performance levels of the team. Responsibilities may vary depending on seasonal business needs.

Why Southwestern Health Resources 

As a Southwestern Health Resources employee, you’ll enjoy, comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.

• Additional perks of being an SWHR employee:
• Gain a sense of accomplishment by contributing to a teamwork environment.
• Positively impact patients’ quality of life.
• Receive excellent mentorship, comprehensive training and dedicated clinical and administrative leadership resources.
• Enjoy opportunities for growth.

Explore Southwestern Health Resources Careers for more information and to search all career opportunities.

Our Recruitment team invites you to contact us with any questions at recruitment@texashealth.org