Mass General Brigham Health Plan · 2 days ago
Medicare Advantage Quality Assurance Team Lead
Somerville, MA
Full-time
Remote
Mid Level
4+ years exp
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Responsibilities
Provide daily direction and support for the QC Team specific to the Medicare Advantage (MA) line of business, ensuring clear communication and alignment with organizational goals.
Collaborate with the Manager, Quality Control, to continuously monitor and update evaluation forms to ensure accuracy and relevance.
Develop and maintain comprehensive MA job aids and desktop procedures tailored to the QA team’s needs, ensuring they remain current and effective.
Review QA Reviewer evaluations and audit challenges from Medicare Advantage Customer Service Professionals, following established processes to ensure fairness and accuracy.
Conduct monthly audits of Explanation of Benefits (EOB) to ensure accuracy, compliance with Medicare guidelines, and high-quality customer communication.
Deliver ongoing MA Customer Service (CS) updates and training to both new and experienced QA Reviewers, ensuring consistent knowledge and application of Medicare policies and procedures.
Conduct live monthly coaching sessions for CS representatives to enhance skills, address challenges, and reinforce best practices in customer service.
Work closely with MA CS leadership and Learning and Development, Claims, Grievances and Appeal, Enrollment and Compliance teams to identify and address gaps in training programs or Customer Service Guidelines (CSG), enhancing overall service delivery.
Stay up to date on Medicare Advantage Customer Service changes, maintaining a high level of expertise through continuous training and monitoring of updates to ensure team alignment.
Share responsibility for the team’s performance, ensuring tasks are completed efficiently and that required metrics are consistently met or exceeded.
Identify trends and skill gaps using data analysis and propose actionable improvements to enhance overall service delivery.
Anticipate, meet, and exceed internal and external expectations, establishing and maintaining effective relationships across departments to ensure service excellence.
Participate in or lead process improvement workgroups and special projects related to Medicare, driving efficiencies and innovation in service delivery and member experience.
Hold yourself and team members accountable to meet commitments and quality standards.
Ensure that diversity, equity, and inclusion are integral to all practices and decision-making processes within the team.
Persist in achieving objectives, overcoming obstacles, and maintaining focus on results, regardless of challenges encountered.
Build and foster strong relationships that reinforce the company’s position as a people-first organization, centered on delivering quality care and service.
Perform other duties as assigned, with or without accommodation, to support the organization’s goals within the Medicare line of business.
Qualification
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Required
A high school diploma or GED is required, plus 4 years in a customer service environment.
Extensive knowledge of Medicare Advantage a plus.
Knowledge of customer service principles and practices.
Knowledge on Microsoft Office (Teams, Excel, Outlook, etc.)
Excellent verbal and written communication skills.
Ability to work independently and part of a team.
Preferred
2+ years of Medicare Advantage Customer Service experience is strongly preferred.
Knowledge of call center telephony and technology is preferred.
Company
Mass General Brigham Health Plan
Mass General Brigham Health Plan is an insurance company that offers health plans and research for employees in an organization.
Founded in 1986Somerville, Massachusetts, USA
201-500 employees
H1B Sponsorship
Mass General Brigham Health Plan has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2023 (3)
Funding
Current Stage
Growth StageLeadership Team
Steven Tringale
President
Recent News
2022-07-01
FierceHealthcare
2022-07-01
Business Journals
2022-05-04
Company data provided by crunchbase
