Quality Audit Specialist - Internal Applicants Only

Let’s do great things, together!

About Moda
Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be better together.

Position Summary

The Customer Service Quality Specialist I plays a vital role in enhancing customer service interactions by evaluating performance and fostering team collaboration to uphold service standards. This position is essential in driving customer satisfaction and improving team effectiveness across all Moda and Delta Dental Customer Service teams. To ensure high-quality interactions, the Specialist reviews a variety of communications, including call recordings, voicemails, emails, and chat transcripts, generated by Customer Service Representatives, Technical Support Specialists, third-party vendors, department leaders, and trainees. Constructive feedback is systematically provided to ensure quality assurance across all contact channels. Additionally, ongoing training is offered as needed to continuously improve  service delivery and enhance customer experience. This is FT hybrid position based in Milwaukie, Oregon.

Pay Range
$21.30 - $23.96 hourly (depending on experience)
**Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.

Please fill out an application on our company page, linked below, to be considered for this position.

Benefits :

• Medical, Dental, Vision, Pharmacy, Life, & Disability
• 401K- Matching
• FSA
• Employee Assistance Program
• PTO and Company Paid Holidays

Required Skills, Experience & Education:

1. High School diploma or equivalent.
2. Minimum of 6 months of experience in Customer Service or Call Center roles, preferably within healthcare. Experience should include handling escalated interactions via phone, email, or chat, and resolving complex issues.
3. Minimum of 10-key proficiency of 130 kpm and a minimum of typing proficiency of 50 wpm.
4. Proficiency with Microsoft Office, Moda operating systems, and NICE software.
5. Knowledge of one Customer Service-related department (e.g., Medical, Pharmacy, Dental, CS Tech Support, BHS, OHP, and EOCCO) with the ability to cross-train across multiple lines of business.
6. Familiarity with Moda Health administrative policies and procedures affecting claims and customer service.
7. Understanding of large group and individual healthcare insurance dynamics and provisions, including funding types, benefit designs, and Moda Health/Delta Dental benefit administration policies.
8. Strong reading, writing and verbal communication skills with the ability to interact in a professional, patient, and courteous manner.
9. Strong communication and collaboration skills.
10. Ability to maintain confidentiality and exhibit a professional business demeanor.
11. Strong analytical, problem-solving, and decision-making skills with keen attention to detail.
12. Ability to quickly adapt to program changes while ensuring tasks are completed efficiently.
13. Capacity to perform under pressure in a fast-paced, complex environment with shifting priorities.
14. Strong organizational skills with the ability to manage multiple projects and meet deadlines.
15. Attendance that meets or exceeds company standards is expected.

Primary Functions :

1. Conduct comprehensive audits across various customer service channels, including online chat, inbound/outbound phone calls, internal/external emails, and post-contact surveys.
2. Audit customer service interactions utilizing approved criteria and NCQA guidelines; identify interactions requiring immediate coaching, follow-up, or correction.
3. Monitor and assess customer interactions across all channels to ensure compliance with established quality standards.
4. Strive for accurate scoring by actively participating in calibration sessions, which help align evaluation standards across teams.
5. Develop and maintain QA scorecards that promote consistency, fairness, and alignment with company expectations.
6. Deliver actionable and constructive feedback to Representatives to support professional development and improve service quality.
7. Analyze QA results to identify knowledge or skill gaps and collaborate with leadership to develop targeted training initiatives.
8. Partner with leadership to create and implement initiatives that improve customer satisfaction and drive performance.
9. Maintain up-to-date knowledge of company policies, procedures, and products to ensure accurate and relevant evaluations.
10. Recommend process improvements to QA tools and methodologies to enhance overall efficiency and effectiveness.
11. Collaborate with leadership to regularly review and refine internal documentation.
12. Foster a positive, collaborative work environment and demonstrate a strong commitment to teamwork and service excellence.
13. Assist with the development and training of new Quality Audit Specialists and support team calibration.
14. Transcribe calls as requested.
15. Perform other duties as assigned.

Working Conditions & Contact with Others

• Office environment with extensive close PC and keyboard use, constant sitting, and frequent phone communication. Must be able to navigate multiple computer screens. A reliable, high-speed, hard-wired internet connection required to support remote or hybrid work. Must be comfortable being on camera for virtual training and meetings. Work in excess of standard workweek, including evenings and occasional weekends, to meet business need.

• Internally with Claims, Sales and Account Services, Membership Accounting, Benefit Configuration, Information Services, Customer Service, and Provider Relations. Externally with members, providers, other insurers, and agents.

Together, we can be more. We can be better.
 
Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training. 

For more information regarding accommodations, please direct your questions to Kristy Nehler & Danielle Baker via our View email address on j.brt.mv email.

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