Manager of Call Center Quality and Compliance

About NYC Health + Hospitals

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth‘s network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The Manager of Call Center Quality and Compliance is responsible for the day-to-day management of the Quality Assurance and compliance team. This includes ensuring that quality audits are performed according to the Quality Assurance Scoring Guidelines, providing feedback to direct reports, serving as a liaison between the Call Center Operations management staff and the Quality Assurance team, and hiring, training, coaching, counseling, and evaluating the performance of direct reports.

Job Description

• Manage the day-to-day operations of the Quality Assurance and Compliance team.
• Ensure that quality audits are performed according to the Quality Assurance Scoring Guidelines
• Provide monthly feedback to all direct reports through coaching sessions utilizing quality scorecards to measure performance.
• Serve as a liaison between the Call Center Operations management staff and the Quality Assurance team.
• Hire, train, coach, counsel, and evaluate the performance of direct reports.
• Conduct daily/weekly huddles with the team providing knowledge refreshers and organizational updates.
• Maintain knowledge of all policies, procedures, and regulations as it relates to MetroPlusHealth.
• Participate in the audit on all delegated vendors for which Call Center is responsible.
• Oversee all Quality Assurance special projects, like secret shopper calls and post-call surveys.
• Oversee, track, and trend the secret shopper calls to the Call Center to assess the Customer Service Representatives (CSR)
• Perform second level quality audits (rebuttals) for CSR calls.
• Participate in audit readiness and reviews.
• Contribute to the development and maintenance of customer services policy, procedures, internal desk manuals, and workflows.
• Support the development of knowledge management tools, including new workflows, and troubleshoot problems.
• Work with the training team to ensure that all CSR training materials are up to date.
• Participate in User Acceptance Testing (UAT) for new systems or implementations and provide feedback.
• Identify opportunities for content additions and improvements.
• Analyze information needs, propose solutions, and follow through on measuring improvement.
• Propose and implement plans to update information.
• Provide administrative support to extrapolate relevant data and develop awareness for policy updates/changes.
• Utilize QA data to analyze, identify trends and skill gaps, and provide recommendations to management for an optimized customer experience.

Minimum Qualifications

• Bachelor’s degree required.
• Minimum 3-5 years of related experience in a healthcare industry.
• Strong knowledge of Quality Assurance principles and practices.
• Knowledge of Quality Assurance and Compliance principles and practices
• Experience with Quality Assurance software and reporting tools
• Experience with call center software and reporting tools.
• Experience with Six Sigma or other quality improvement methodologies.
• Knowledge of Managed Care is a plus.
• High Proficiency in Excel.
• Bilingual is a plus (Spanish, Bengali, Creole, Mandarin, Cantonese, French).
• System Knowledge: Calabrio, Salesforce, Tableau.

Professional Competencies

• Excellent communication and interpersonal skills.
• Ability to manage and motivate a team.
• Ability to work independently and as part of a team.
• Strong analytical and problem-solving skills.
• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Written/Oral Communication

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