The primary objective of this position is to audit Customer Service calls for all CHRISTUS product lines, measure and report quality results and identify trends and opportunities for improvement. Customer Service calls are evaluated against established criteria which includes but are not limited to accuracy of information provided on claims, benefits and eligibility, provider network status, soft skills, and HIPPA
Identify prevalent trends and recommend resolution techniques to management.
Ensures 10% calls and events are performed per agent, per month.
Assist with inbound calls during peak call periods, as directed by department Manager
Identify additional training needs based on review and analysis of quality monitoring results.
Share ideas/recommendations for process improvements for monitoring and training with management team.
Develop and coordinate the implementation of systems, procedures and forms to improve data collection.
Assist in the development of action plans to address quality deficiencies.
Ability to coach agents in areas of concern by reviewing calls, or system notes, to ensure agent understands audit results.
Produce weekly, monthly, quarterly and annual management and operations focused reports in a timely manner.
Assist in developing and maintaining dashboard to report Corporate and Client Quality results.
Identifies and escalates process issues, system defects and errors in instructional material to appropriate team and management
Ability to organize and prioritize work to meet deadlines
Strong computer application skills including Microsoft Word, Excel and Visio
Excellent written and verbal communication skills required
Good judgment, initiative and problem solving abilities
Ability to handle and resolve complex issues independently
Knowledge of Medicaid, Medicare Advantage, Tricare and Health Care Exchange programs preferred
Knowledge of claims processing, provider status, benefits and eligibility
Ability to learn new policies and processes based on written material and observation
Ability to establish and maintain professional, positive and effective work relationships
Prior Customer service experience require
Experience with claims status, benefits, and eligibility required
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.