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Quality Specialist I

Durham, North Carolina Apply Now Job ID 1164413 Category Quality Assurance Organization Carolina Complete Health Schedule Full-time
Description:
Position Purpose: Perform quality reviews to ensure high level of customer service and/or accuracy in processing claims and transactions.

  • Conduct procedural and quality reviews/audits to ensure adherence to policies and procedures and high levels of customer service, satisfaction and accuracy using applicable tools and technologies
  • Provide written documentation to management regarding quality review/audit results
  • Collaborate with various cross functional departments to identify training needs, system errors, processing errors, etc. and develop work plans and processes
  • Participate in continuous quality improvement initiatives and serve as a resource to others regarding quality concerns
  • Analyze data to ensure adjustments/changes yielded anticipated results
  • Asist with managing databases, policies and procedures related to assigned areas
  • Complete special projects as needed
  • 10% travel may be required.
  • Qualifications:


    Education/Experience: High School Diploma or equivalent. 4+ of combined call center/customer service and training/auditing/data analysis experience. Knowledge of insurance or healthcare products and procedures highly preferred. Depending on the state, bi-lingual skills may be preferred.

    Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
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    • Quality Assurance, Durham, North Carolina, United StatesRemove

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