Senior Customer Experience Quality / Business Analyst - Provider Enrollment

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at HMS, a Gainwell Company carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

Summary

As a Senior Customer Experience Quality / Business Analyst - Provider Enrollment at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges.

Customer Experience Professional Quality position is responsible for monitoring and evaluating the quality of inbound and outbound interactions. You will support our quality commitment of exceptional, accurate, and compliant execution of work through measurement, analysis, and review of agent and account calls and transactions and compliance, and of related business processes and surveys. You will be responsible for executing daily quality assurance reviews and processing audits: first-level reviews of business processes which involve reviewing documentation to ensure activities are in line with Account, Customer Experience (CX) and Company standards, policies, and procedures. You will participate in the planning, execution, and delivery of quality assurance related initiatives. Partnering with your immediate, centralized, and account team members, the work you deliver will drive improved employee, member, and client experiences and achievement of Account and company goals and objectives.

Here are the details on this position.

Your role in our mission

Play a critical part in ensuring Gainwell is meeting our clients’ objectives in important areas.

• Regularly evaluate customer interactions (calls, emails, chat, transactions, etc.), to include complex interactions, to assess adherence to established quality standards and regulatory compliance requirements.
• Embrace and utilizes procedural and technology automation to support the effective and efficient evolution of QA support.
• Proactively engage to support, occasionally lead, and consistently add value in calibration sessions to deliver consistency in quality evaluations.
• Facilitate knowledge sharing and alignment with key stakeholders through routine engagement sessions.
• Leverages adhoc reporting delivers results inclusive of key observations, recommendations, and trending to appropriate peer coaching to the various levels of leadership and applicable.
• Strive to personally resolve or escalate unresolved issues to an appropriate level to include negative customer experiences.
• Synthesize personal quality behavioral observations to inform insights and trending.
• Make recommendations and suggest initiatives for process and policy enhancements based on data-driven insights.
• Remain current with industry best practices for contact center quality assurance.

What we're looking for

• Minimum of 5+ years performing quality assurance and analysis required within the Healthcare industry or subject matter expertise experience - quality assurance principles, methodology and practices
• Minimum of 3 years working in Provider Enrollment and/or Credentialing required, 5 years of experience preferred.
• Bachelor's degree or equivalent combination of education and experience
• Demonstrated knowledge of two or more MMIS business areas (Authorized Services, Member / Provider Contact Center Customer Service / Helpline, Mailroom, Pharmacy, Provider Enrollment, etc.) and experience partnering with operations staff assigned to multiple areas.
• Experience utilizing Microsoft Office suite and Salesforce software contact center and back-office contract center operations (CXOne, Verint, SharePointe, etc.).
• Effective written and oral communication and interpersonal skills to work effectively with team members, customers, and clients.