QA and Compliance Specialist - 61862

Full Time | New York City, NEW YORK | about 2 months

Job Summary

Full Time

$116,957 Average salary of similar jobs | Check Salary...

Job Description


About NYC Health + Hospitals

MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. 

Position Overview

The primary responsibility of the QA and Compliance Specialist is to monitor and audit calls that come into the Call Center department, and to ensure our Customer Service Representatives (CSRs) provide exceptional customer service to our members, prospective members, and providers.



Job Description

  • Conduct quality assurance on a percentage of CSR calls, ensuring compliance to federal and state regulatory standards.
  • Conduct audits on all delegated vendors for which Customer Services is responsible
  • Participate in audit readiness and reviews.
  • Contribute to the development and maintenance of customer services policy, procedures, and internal desk manuals.
    • Support use of knowledge management tools, including new manuals, and troubleshoot problems.
  • Work with training to ensure that all CSR training materials are up to date. Additionally, develop job aids and refreshers, and maintain a library of knowledge management to deploy to CSRs as needed.
  • Identify opportunities for content additions and improvements.
    • Analyze information needs, propose solutions, and follow through on measuring improvement.
    • Propose and implement plans to update information.
  • Provide administrative support to extrapolate relevant data and develop awareness for policy updates/changes.
  • Utilize QA data to analyze, identify trends and skill gaps, and provide recommendation to management for an optimized customer experience.


Minimum Qualifications

  • Minimum of 3-5 years of related experience (in a highly regulated industry)
  • Education: Bachelor’s Degree
  • Knowledge of Managed Care is a plus
  • High Proficiency in Excel
  • Bilingual is a plus (Spanish, Bengali, Creole, Mandarin, Cantonese, French)
  • System Knowledge: NICE, Verint, Calabrio

Professional Competencies

  • Integrity and Trust
  • Customer Focus
  • Functional/Technical skills
  • Written/Oral Communication

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