Sr Specialist, Medicare Member Engagement (Remote)

Lensa; City of Albany (NY); Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a Sr. Specialist in Member Engagement to enhance the quality of customer interactions. This remote role involves monitoring concierge calls, providing constructive feedback, and collaborating with training teams to improve agent performance. If you have a passion for customer service and quality assurance, and possess strong communication and problem-solving skills, this position offers a unique opportunity to make a significant impact in the healthcare sector. Join a team dedicated to continuous improvement and operational excellence.

Qualifications

• 3+ years in customer service or quality assurance.
• Understanding of managed healthcare and Medicare.

Responsibilities

• Monitor and evaluate concierge call interactions.
• Provide feedback to agents and team leaders.
• Document evaluation results and present findings.

Skills

Customer Service

Quality Assurance

Communication Skills

Problem-Solving Skills

Education

High School Diploma

Associate Degree in Social Work

Bachelor's Degree in Human Services

Tools

Microsoft Office Suite

Genesys

QNIXT

Marx Incomm

WEX

Job description

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Sr. Specialist, Member Engagement - Job Description

The Sr. Specialist, Member Engagement is responsible for monitoring and evaluating member interactions to ensure that concierge agents adhere to established quality standards. The role involves:

1. Monitor and Evaluate Calls: Listening to and reviewing concierge call interactions to assess agent performance against quality standards, including communication skills, adherence to scripts, problem-solving ability, and overall customer service quality.
2. Provide Feedback: Delivering constructive feedback to agents and team leaders, highlighting strengths and areas for improvement, and working with agents to implement strategies for enhancing performance.
3. Report and Document Findings: Accurately documenting evaluation results, creating detailed reports that capture key insights and trends, and presenting findings to management with recommendations for training and development.
4. Collaborate with Training Teams: Working closely with training teams to develop and implement training programs addressing identified areas of improvement.
5. Ensure Compliance: Ensuring all interactions follow company policies, procedures, and regulatory requirements, and reporting breaches or risks.
6. Identify Process Improvements: Recognizing trends in customer interactions and recommending process improvements to enhance customer satisfaction and operational efficiency.
7. Support Continuous Improvement: Participating in quality assurance calibration sessions with team leaders and management to ensure evaluation consistency.
8. Stay Updated: Keeping abreast of industry best practices and emerging trends in quality assurance and customer service.

Qualifications

Required Education: High School Diploma or equivalency.

Required Experience: At least 3 years of experience in customer service, quality assurance, consumer advocacy, or healthcare systems, including conducting intake, interviews, or research of consumer/provider issues. Excellent communication skills and a basic understanding of managed healthcare and Medicare are essential.

Preferred Education: Associate or bachelor’s degree in social work, Human Services, or related fields.

Preferred Experience: Experience with Medicare and managed plans like MAPD, DSNP, MMP; strong problem-solving skills; proficiency in Microsoft Office Suite and quality monitoring tools such as Genesys, QNIXT, Marx Incomm, and WEX.

Additional Information

Molina Healthcare offers a competitive benefits package. The position is remote, with a pay range of $21.16 - $42.20 hourly. Interested employees should apply through the intranet. Molina is an EOE M/F/D/V.