Senior quality analyst and outstanding performer in active listening and leadership within healthcare industry. Proven success in leadership, operational excellence and organizational development with keen understanding of elements of health business. Recognized for inspiring management team members to excel and encouraging creative work environments.Detail-oriented Quality Control Analyst well-versed in qualitative and quantitative analysis techniques. Strengths include multitasking, organizing data and prioritizing tasks. Offering 6 years' experience in Medicare and Medicaid quality settings.
Complete monthly Call Quality evaluations for all assigned agents conducting outreach services. Provide clear, concise, accurate, and timely evaluation results/findings that can be effectively utilized.
Reporting monitoring and general quality assurance.
· Provide call quality coaching/training by conducting one-on-one Focus Coaching sessions (as required) with assigned agents to review performance positives and opportunities identified in individual calls not meeting minimum performance standards and expectations.
· Participate in (as required) Call Calibration meetings for each department/team conducting outreach services.
· Provide feedback and insights regarding the quality of the calls being calibrated to ensure alignment of expectations and best practices that will contribute to the overall improvement of call quality for the individual agent, the team and Humana Help Identify trends and patterns, best practices, and make recommendations for improvements in service delivery.
· Provides call quality metric and performance reports to manager.
· Responsible for the related continuous improvement to the current Quality Assurance call monitoring procedures.
· Promote a culture of excellence, working cooperatively with all staff to enhance services and improve operations. Provide solutions as new requirements become necessary.
· Participate (as required) in Humana Health's staff meetings. Be a team player and communicate openly and honestly.
· Demonstrate behaviors, actions, and attitude that reflect Humana Health vision, mission and values.
Monitor, Score and correct all MAPD and PDP documented verbal grievances completed across all UHG and vendor sites within CMS requirements and expectations.
· Maintain production standards and quality goals in order to reduce CMS and DOI escalation from plan participants.
· Provided projected failure rates and feedback to the training department in order to reach positive impact to foreseeable failure areas.
· Reported all metric goals/ results along with regional trends to management team on a monthly basis.
· Conducted calibration sessions with the Validation team in order to improve consistency and reduce the team's error rate.
Responsible for ensuring that call center service levels such as Adherence, Quality, Compliance and Average Handle Time were met. Also, implement any necessary changes to guarantee that contractual performance goals were met.
· Developed a functional relationship with all Operational Business Partners in order to develop new service products as well as the development/ revision of any policy and procedures.
· Maintained close relations with all international clients to alert and correct any operational gaps and involve all necessary segments for a swift and seamless resolution.
· Reported all metric goals/ results along with regional trends to Regional Executive team on a monthly basis.
· Managed the regional call center centralization project by hiring and on-boarding over 130 new employees, as well as the development of supportive staff.
· Development of the Employee Service Committee, design to decrease attrition and increase employee satisfaction.
Monitors and coaches assigned team members to attain internal and external KPIs.
· Trained operational and customer service teams regarding grievance and appeals for all Medicare and Medicaid plans.
· Developing workflows, systems operations and policy production.
· Diagnosed and developed process improvements opportunities for sales events and program collaborations.
· Develop and implemented and multi phase lead generation program which included community program participation.
· Scheduled and coordinated community meetings, responded to benefit inquiries and participated in all marketing materials development.
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