Job Description

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at HMS , a Gainwell Company carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

Summary

As a  Senior QA - Provider Enrollment - BA at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges.

This position is responsible for monitoring and evaluating the quality of inbound and outbound interactions. You will support our quality commitment of exceptional, accurate, and compliant execution of work through measurement, analysis, and review of agent and account calls and transactions and compliance, and of related business processes and surveys. You will be responsible for executing daily quality assurance reviews and processing audits: first-level reviews of business processes which involve reviewing documentation to ensure activities are in line with Account, Customer Experience (CX) and Company standards, policies, and procedures. You will participate in the planning, execution, and delivery of quality assurance related initiatives. Partnering with your immediate, centralized, and account team members, the work you deliver will drive improved employee, member, and client experiences and achievement of Account and company goals and objectives.

Here are the details on this position.

Your role in our mission

Play a critical part in ensuring Gainwell is meeting our clients’ objectives in important areas.

• Regularly evaluate customer interactions (calls, emails, chat, transactions, etc.), to include complex interactions, to assess adherence to established quality standards and regulatory compliance requirements.
• Embrace and utilizes procedural and technology automation to support the effective and efficient evolution of QA support.
• Proactively engage to support, occasionally lead, and consistently add value in calibration sessions to deliver consistency in quality evaluations.
• Facilitate knowledge sharing and alignment with key stakeholders through routine engagement sessions.
• Leverages adhoc reporting delivers results inclusive of key observations, recommendations, and trending to appropriate peer coaching to the various levels of leadership and applicable.
• Strive to personally resolve or escalate unresolved issues to an appropriate level to include negative customer experiences.
• Synthesize personal quality behavioral observations to inform insights and trending.
• Make recommendations and suggest initiatives for process and policy enhancements based on data-driven insights.
• Remain current with industry best practices for contact center quality assurance.

What we're looking for

• Minimum of 5+ years performing quality assurance and analysis required within the Healthcare industry or subject matter expertise experience - quality assurance principles, methodology and practices
• Minimum of 3 years working in Provider Enrollment and/or Credentialing required, 5 years of experience preferred.
• Bachelor's degree or equivalent combination of education and experience
• Demonstrated knowledge of two or more MMIS business areas (Authorized Services, Member / Provider Contact Center Customer Service / Helpline, Mailroom, Pharmacy, Provider Enrollment, etc.) and experience partnering with operations staff assigned to multiple areas.
• Experience utilizing Microsoft Office suite and Salesforce software contact center and back-office contract center operations (CXOne, Verint, SharePointe, etc.).
• Effective written and oral communication and interpersonal skills to work effectively with team members, customers, and clients.
• Demonstrated strategic initiative implementation and execution, specifically with operating policies and procedures and work process improvements in customer contact operations. 

Additional Preferred Qualifications

• Knowledge and experience of quality metrics and contact center quality technology platforms
• Strong organizational and time management skills.
• Skilled at working independently and as part of a team.
• Demonstrated capability to embrace and implement change in personal workspace.

What you should expect in this role

Preferred Location:

• Candidates residing in Alaska are strongly preferred.
• Hybrid Option: Individuals living within 1 hour of Anchorage, AK may be eligible for a hybrid schedule (combination of remote and in-office work).
• Remote Option: Fully remote arrangements may be considered for highly qualified candidates .

Additional expectations:

• Video cameras must be used during all interviews and during the initial week of orientation.
• To effectively work as a teleworker with Gainwell, employees' Broadband Internet connections should have a minimum speed of 24MBS download and 8 MBS

• The deadline to submit applications for this posting has been extended until a suitable candidate is selected

• #LI-Alaska
• #LI-Provider Enrollment
•  

The pay range for this position is $74,300.00 - $106,100.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at HMS , a Gainwell Company . You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with HMS , a Gainwell Company , an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about HMS , A Gainwell Technologies Company at our  company website and visit our  Careers site for all available job role openings.

HMS, a Gainwell Company,  is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. 

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