QA Associate | Claims Associate

Job Description

Job Description

Job Title: QA Associate | Claims Associate
Job Location: Pittsburgh, PA 15275
Job Duration: 6 Months (Possibilities of Extension)
Shift: Monday - Friday, 8:00AM - 4:30PM

• The Operations Quality Assurance Associate will evaluate work completed by Operations agents a Products program SOPs, WINs, business rules, and other program-related documents for adherence to expectations outlined in the documents.
• The QA Associate I must be able to use objective decision-making and critical thinking skills to determine whether audited work meets internal and external expectations.
• The Operations Quality Assurance Associate I will be a subject matter expert for their respective assigned business unit(s) and will utilize analytical skills to analyze data, processes, and workflows to provide insightful, actionable coaching for the Operations Agents.

• Coach Operations agents (peer to peer) on areas of opportunity for improvement found during evaluations, collaborate with training for Operations agents (i.e., new hire, refresher, and nesting training)
• Performs and documents results of all quality assurance evaluations on all operational products and services, including (but not limited to) benefit verification cases, patient assistance cases, software support calls/emails, inbound calls from patients or health care providers, data entry, etc.
• Participates in internal, vendor, or client calibration meetings as required to address quality initiatives but does not lead them
• Identifies and escalates critical quality issues appropriately to senior management
• Assists with other QA-related functions and responsibilities as needed to meet department and company goals
• Sending feedback to Operations leadership on agent performance
• Attending meetings, helping with data analysis, and other duties as assigned

• Highschool or relevant experience
• 1 – 3 years as a Case Manager, Benefit Verification Specialist, or Contact Center agent, or equivalent experience in a similar role in another company, or 1 – 3 years of prior quality control experience
• Knowledge Solid working knowledge of quality-orientated services such as accuracy management, performance metrics, customer experience/satisfaction, healthcare benefits, and SOP execution. Health Care Experience is required, specifically claim processing, contact center, benefit verification, or similar industry experience. Call Center and/or Claim Processing experience is a plus.
• Problem-solving, results-oriented, active listening, and high attention to detail. Monitor telephone calls and communications between The Customer and The Customer Care Center.