SCOPE OF ROLE

The Quality Assurance Analyst (Enrollment & Billing) assists and coaches individuals on the MES Team to ensure that all individuals are providing exceptional customer service for our Bright customers.

ROLE RESPONSIBILITIES

The Quality Assurance Analyst (Enrollment & Billing) job description is intended to point out major responsibilities within the role, but it is not limited to these items.

• Utilize knowledge of State-based exchange, Federal Facilitated Marketplace (FFM) and Brighthealth procedures to accurately evaluate telephone, email and contact center interactions for alignment with defined processes and procedures; meets established goals and metrics, as business needs require.
• Provide training and guidance, verbally and in writing, to associates and Supervisors related to areas of opportunity; share best practices.
• Participate in the discovery and resolution of root cause(s) of recurring issues; Isolate, replicate and document defects and suggest alternatives to provide better outcomes.
• Daily, Weekly, and Monthly Reporting.
• Assist with Escalated calls.
• Other duties and responsibilities as assigned.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• High School diploma or GED required.
• Two (2) years experience in a customer service role required
• One (1) year experience in a lead or supervisor role preferred
• One (1) year experience auditing transaction (phone, email, chat, etc) and providing constructive feedback required, preferably in the healthcare and/or in a high-volume contact center environment
• Working knowledge and/or experience working with Individual Family Health Plans (IFP), Federally Facilitated Marketplace (FFM), the Affordable Care Act (ACA), or experience in a related healthcare industry preferred.
• Basic computer skills, inclusive of Microsoft office required.

PROFESSIONAL COMPETENCIES

• Must be detailed oriented and present critical analytical thinking skills
• Must display active listening skills
• Organized and be able to prioritize work to meet deadlines
• Collaborate effectively with internal and external partners to resolve issues for our members.
• Must present strong ability to read and comprehend material presented both orally and in writing
• Strong communication skills, both verbal and written
• Comfortable applying basic math skills
• Works independently with little supervision
• Able to thrive and adapt in a fast paced, stressful environment
• Must be flexible to change and open to learning new tasks as assigned
• Must have intermediate skills using Microsoft Office, along with general computer and typing skills

LICENSURES AND CERTIFICATIONS

Producer licensing for Health & Accident may be required in the state in which an individual resides for OEP 2020 or before an individual will be able to transition into a FTE MES role. (Potential temp to FTE is a minimum of 6 months.)

WORK ENVIRONMENT

The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer. Travel may be required.