Call Quality Assurance Analyst (CHC)
Community Health Choice, Inc. (Community) is a non-profit Health Maintenance Organization (HMO) licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 70 hospitals, Community serves over 260,000 Members with the following programs:
• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.
Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.
The Call Quality Assurance Analyst will monitor inbound/outbound calls within the Member Operations Call Center for quality assurance purposes. The Call Quality Assurance Analyst will serve as the subject matter expert for all lines of business so that reviews of calls are accurate for technical content and employees are provided with the correct policies, procedures, and/or reference materials for the correct processing of member information and/or request for action completion. The Call Quality Assurance Analyst will monitor calls on a sliding scale each month for new and tenured employees with a focus on timeliness of answer, soft skills, to include, but not limited to active listening, request/issue identification to include primary and secondary issues, correct call hold, professionalism, compliance requirements, request/issue resolution, and appropriate closing. The Call Quality Assurance Analyst will utilize the current call monitoring evaluation form to complete call monitoring for Member Service Representative. The Call Quality Assurance Analyst will document areas of improvement to include ¿high risk¿ issues such as Quality of Care that may require immediate attention as coaching for the employee for continued call quality growth and development. The Call Quality Assurance Analyst will make recommendations for evaluation form changes. The Call Quality Assurance Analyst will complete individual and/or team coaching to address high risk issues. The Call Quality Assurance Analyst will deliver upon completion call data to the Member Service Representative and manager/team lead evaluation data to include, score, areas of proficiencies/deficiency. The Call Quality Assurance Analyst will identify trends in service and provide that data to the training team to enhance and/or make modifications to current training. The Call Quality Assurance Analyst will review all rebuttal requests for call re-evaluation as submitted by the Member Services management team. The Call Quality Assurance Analyst will lead and or participate in monthly call calibration with the Member Services management team.
Benefits and EEOC
Community employees’ benefits are provided by Harris Health. These benefits are designed to provide you with flexibility and choices in meeting your specific needs.
Community is an Equal Opportunity Employer.