Claims Quality Analyst

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

The purpose of this role is to promote excellent call quality, contact handling and documentation by providing an additional consistent monitoring measurement.

Job title:

Claims Quality Analyst

Job Description:

Education:

High School Graduate is required

Experience:

Min 1-2 years of experience in a call center managing the inbound calls (same experience needed in Claims process in case of back office)

Mandatory Skills:

• Must be good in coaching skills (for coaching the CSR based on their call quality)

• Must be proficient in typing speed

• Excellent written and verbal communication skills

• Excellent time management skills

• Strong keyboarding/computer skills, including Microsoft Word and Excel 

• Must be detail oriented with good observation skills.

Roles & Responsibilities:

• Remotely monitors customer service skills of all customer service representatives to ensure quality of call handling, accurate coding in CRS and making appropriate documentation.

• Completes established monitoring objectives in accordance with applicable SOP’s. 

• Provides written and oral feedback to the CSR on all calls monitored. 

• Completes daily statistical reports and spreadsheets according to standard procedure. 

• Completes Quality Control Reports as assigned on a daily basis, makes corrections to CRS when errors exist and documents the contact.

• Attends weekly and monthly department meetings to calibrate monitoring measurements.

• Notifies management immediately of serious infractions in a Customer Service Representative’s call quality.

• Follows all client SOP’s and applicable work related guidance documents.

• Responsibilities may include taking Supervisory calls and escalations.

• Ensure daily / weekly / monthly audit targets are met.

• Ensure audits are completed as per client requirements and ATA is maintained.

• Ensure to take calls whenever needed as specified by the manager.  

Salary: $18.00 and up dependent on experience and location

Sagility Offers Competitive Benefits Including:

• Medical

• Dental

• Vision

• Life Insurance

• Short-Term and Long-Term Disability

• Flexible Spending Account

• Life Assistance Program

• 401K with employer contribution

• PTO and Sick Time

• Tuition Reimbursement

Join our team, we look forward to talking with you!

An Equal Opportunity Employer/Vet/Disability

Location:

Work@Home USAUnited States of America