Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 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.
• Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.
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.
JOB SUMMARY: The Service Quality Coordinator will audit, evaluate, and score inbound/outbound calls, electronic correspondence, and interactions with the public. This role participates in call calibrations to ensure grading is consistent with processes across the lines of business. The Service Quality Coordinator will work to ensure that employees are following the correct policies, procedures, and regulatory guidelines for their respective scope of work.
JOB SPECIFICATIONS AND CORE COMPETENCIES
70% Call Quality Evaluations: Responsible for auditing calls, reviewing electronic correspondence, and observing interactions with the public on new and tenured employees.
20% Call Quality Calibration: Participate and/or lead monthly calibration sessions to ensure that calls are being evaluated equally and with minor deviations.
10% Training: Reports to management areas of deficiency which may require revisions to training material and or processes.
Education/Specialized Training/Licensure: High School diploma or GED equivalent
Work Experience: Four years related experience in health care / plan customer service Quality Assurance Call monitoring preferred.
Software Proficiencies: Microsoft Office (Word, Excel, Outlook)
Experience working with NICE, Verint, Oaysis and/or other call quality recording software and evaluation technology.
Attention to Detail
Bilingual: Spanish or threshold language preferred