Auditor - Call Center (HealthCare)
Regal Medical Group Regal Medical Group Northridge, CA Northridge, CA Full-time Full-time $22.
50 - $24.
50 an hour $22.
50 - $24.
50 an hour 15 hours ago 15 hours ago 15 hours ago We are looking to hire an Auditor for our Member Services team with Healthcare experience to complete routine audits on individuals' member services representatives on Customer Service Module and REA/LEAD customers service cases.
This role would be responsible for training the customer service representatives and answers questions relating to eligibility, referrals, provider availability, claims status and department procedures.
Handling escalated inquiries from members, Health Plans, providers and employer groups, to provide information and clarification on RMG services.
Essential Duties and Responsibilities include the following:
Audit 2% of each Member Service Representatives' calls will be monitored with at least 1 random call monthly.
This will include quality assurance evaluations for inbound/outbound calls In addition this will include high priority calls such as new hires, most complaints, high hold, and talk time.
Conduct and maintain quality assurance progress reports, conduct Q&A reviews by listening to recorded calls and providing training and feedback as necessary Audit documentation for accuracy of the customer service module and REA/LEAD Customer Service Cases Calls monitored shall be sampled randomly to represent varying days of the week, week of the month, hours of the day, and monitors/reviewers.
The data is entered into the Telephone-Audit Random Review Form.
The results are entered into the score card Sampling should be based on the number of calls required per Member Service Rep regardless of the type of call handled.
If the minimum is 3 calls per quarter, a bilingual Member Service Rep would only need a total of 3 calls for the month, not 3 for each language.
However, the monthly sample for bilingual Member Service Rep should include calls in both languages, if it is feasible to do so.
Member Service Rep shall receive a copy of the scorecard for every call monitored so that they can track their performance and identify areas for improvement.
The Member Service Rep must sign receipt of the scorecard no later than two work days after the call took place if monitored live or seven work days if the call was recorded.
Keep track of quality results to determine Member Service Rep's areas of opportunity to create an improvement action plan and explain to Member Service Rep what their areas of opportunities are and how it affects the member's perspective so we can deliver a good quality customer service experience.
Work Side by Side with Member Service Rep to help them develop skills to improve in their areas of opportunity and give examples of scenarios and how to respond to them by doing key roles.
Have Member Service Rep listen to call examples of outstanding calls where a great customer service experience was given and have the outlier Auditor that coaches the call shall sign and date the scorecard on the date that coaching is given.
If the person doing the coaching is the same person that monitored the call, he/she must sign and date the scorecard in both places.
The Member Service Rep.
must sign and date the bottom of the scorecard upon receipt-- Audit member service incident reports for RMG, LMG, GCMG and ADOC for timeliness Conduct weekly procedural training meetings with customer service representatives to address current issues that impact the Member Service Department, interact with leadership group to aid in overall staff development and training Attend daily and weekly meetings with supervisors and department manager and provide written status and progress reports.
Work independently and make Auditor/Team Lead decisions when necessary.
Handle a multitude of assignments and prioritize work in order to maintain workflow.
Provide assistance and mentoring to other customer service representatives or personnel as needed.
Ensure written and verbal communication with all levels of management, staff, vendors and property management or accurate and with good grammar.
Maintain confidentiality with all information pertaining to the members medical information Have the required ability to operate well in a call center team environment as a team leader.
Have a very strong knowledge of customer care techniques and processes.
Documentation such as general reports on each team member's performance and targets as well as ensuring that they exceed the targets.
Education and / or
Experience:
High School Graduate or equivalent required.
3 year experience in medical office, related field, including customer service duties Ability to deal responsibly with matters of a confidential nature.
Ability to prioritize work in order to meet daily deadlines.
Must have excellent communication skills, both verbal and written.
Ability to read, write and understand the English language.
Pleasant telephone manner.
Working knowledge of MS Word.
The pay range for this position at commencement of employment is expected to be between $22.
50- $24.
50 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.
The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.
Details of participation in these benefit plans will be provided if an employee receives an offer of employment.
If hired, employee will be in an at-will position and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.
As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment.
Opportunities abound, and enterprising, capable, focused people prosper with us.
We promote teamwork, nurture learning, and encourage advancement for all of our employees.
We want to see you excel, because we believe that your success is our success.
Full Time Position
Benefits:
The success of any company depends on its employees.
For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members.
As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.
Our dedication to our staff is evident in our comprehensive benefits package.
We offer a very generous mixture of benefits, including many employer-paid options.
Health and Wellness:
Employer-paid comprehensive medical, pharmacy, and dental for employees Vision insurance Zero co-payments for employed physician office visits Flexible Spending Account (FSA) Employer-Paid Life Insurance Employee Assistance Program (EAP) Behavioral Health Services Savings and Retirement:
401k Retirement Savings Plan Income Protection Insurance Other
Benefits:
Vacation Time Company celebrations Employee Assistance Program Employee Referral Bonus Tuition Reimbursement License Renewal CEU Cost Reimbursement Program Business-casual working environment Sick days Paid holidays Mileage Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.
Job Type:
Full-time Pay:
$22.
50 - $24.
50 per hour Expected hours:
40 per week
Benefits:
401(k) 401(k) matching Dental insurance Flexible schedule Health insurance Life insurance Paid time off Vision insurance Schedule:
8 hour shift Day shift Monday to Friday Work Location:
In person.
Estimated Salary: $20 to $28 per hour based on qualifications.
50 - $24.
50 an hour $22.
50 - $24.
50 an hour 15 hours ago 15 hours ago 15 hours ago We are looking to hire an Auditor for our Member Services team with Healthcare experience to complete routine audits on individuals' member services representatives on Customer Service Module and REA/LEAD customers service cases.
This role would be responsible for training the customer service representatives and answers questions relating to eligibility, referrals, provider availability, claims status and department procedures.
Handling escalated inquiries from members, Health Plans, providers and employer groups, to provide information and clarification on RMG services.
Essential Duties and Responsibilities include the following:
Audit 2% of each Member Service Representatives' calls will be monitored with at least 1 random call monthly.
This will include quality assurance evaluations for inbound/outbound calls In addition this will include high priority calls such as new hires, most complaints, high hold, and talk time.
Conduct and maintain quality assurance progress reports, conduct Q&A reviews by listening to recorded calls and providing training and feedback as necessary Audit documentation for accuracy of the customer service module and REA/LEAD Customer Service Cases Calls monitored shall be sampled randomly to represent varying days of the week, week of the month, hours of the day, and monitors/reviewers.
The data is entered into the Telephone-Audit Random Review Form.
The results are entered into the score card Sampling should be based on the number of calls required per Member Service Rep regardless of the type of call handled.
If the minimum is 3 calls per quarter, a bilingual Member Service Rep would only need a total of 3 calls for the month, not 3 for each language.
However, the monthly sample for bilingual Member Service Rep should include calls in both languages, if it is feasible to do so.
Member Service Rep shall receive a copy of the scorecard for every call monitored so that they can track their performance and identify areas for improvement.
The Member Service Rep must sign receipt of the scorecard no later than two work days after the call took place if monitored live or seven work days if the call was recorded.
Keep track of quality results to determine Member Service Rep's areas of opportunity to create an improvement action plan and explain to Member Service Rep what their areas of opportunities are and how it affects the member's perspective so we can deliver a good quality customer service experience.
Work Side by Side with Member Service Rep to help them develop skills to improve in their areas of opportunity and give examples of scenarios and how to respond to them by doing key roles.
Have Member Service Rep listen to call examples of outstanding calls where a great customer service experience was given and have the outlier Auditor that coaches the call shall sign and date the scorecard on the date that coaching is given.
If the person doing the coaching is the same person that monitored the call, he/she must sign and date the scorecard in both places.
The Member Service Rep.
must sign and date the bottom of the scorecard upon receipt-- Audit member service incident reports for RMG, LMG, GCMG and ADOC for timeliness Conduct weekly procedural training meetings with customer service representatives to address current issues that impact the Member Service Department, interact with leadership group to aid in overall staff development and training Attend daily and weekly meetings with supervisors and department manager and provide written status and progress reports.
Work independently and make Auditor/Team Lead decisions when necessary.
Handle a multitude of assignments and prioritize work in order to maintain workflow.
Provide assistance and mentoring to other customer service representatives or personnel as needed.
Ensure written and verbal communication with all levels of management, staff, vendors and property management or accurate and with good grammar.
Maintain confidentiality with all information pertaining to the members medical information Have the required ability to operate well in a call center team environment as a team leader.
Have a very strong knowledge of customer care techniques and processes.
Documentation such as general reports on each team member's performance and targets as well as ensuring that they exceed the targets.
Education and / or
Experience:
High School Graduate or equivalent required.
3 year experience in medical office, related field, including customer service duties Ability to deal responsibly with matters of a confidential nature.
Ability to prioritize work in order to meet daily deadlines.
Must have excellent communication skills, both verbal and written.
Ability to read, write and understand the English language.
Pleasant telephone manner.
Working knowledge of MS Word.
The pay range for this position at commencement of employment is expected to be between $22.
50- $24.
50 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.
The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.
Details of participation in these benefit plans will be provided if an employee receives an offer of employment.
If hired, employee will be in an at-will position and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.
As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment.
Opportunities abound, and enterprising, capable, focused people prosper with us.
We promote teamwork, nurture learning, and encourage advancement for all of our employees.
We want to see you excel, because we believe that your success is our success.
Full Time Position
Benefits:
The success of any company depends on its employees.
For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members.
As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.
Our dedication to our staff is evident in our comprehensive benefits package.
We offer a very generous mixture of benefits, including many employer-paid options.
Health and Wellness:
Employer-paid comprehensive medical, pharmacy, and dental for employees Vision insurance Zero co-payments for employed physician office visits Flexible Spending Account (FSA) Employer-Paid Life Insurance Employee Assistance Program (EAP) Behavioral Health Services Savings and Retirement:
401k Retirement Savings Plan Income Protection Insurance Other
Benefits:
Vacation Time Company celebrations Employee Assistance Program Employee Referral Bonus Tuition Reimbursement License Renewal CEU Cost Reimbursement Program Business-casual working environment Sick days Paid holidays Mileage Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.
Job Type:
Full-time Pay:
$22.
50 - $24.
50 per hour Expected hours:
40 per week
Benefits:
401(k) 401(k) matching Dental insurance Flexible schedule Health insurance Life insurance Paid time off Vision insurance Schedule:
8 hour shift Day shift Monday to Friday Work Location:
In person.
Estimated Salary: $20 to $28 per hour based on qualifications.
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