Sales Quality Control Specialist II
Sales & Marketing
Los Angeles, CA, US, 90017
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
The Sales Quality Control Specialist II position will provide support for the implementation, oversight, and continued improvement of quality system processes by conducting call evaluations and auditing the Customer Relationship Management (CRM) records and documentation, monitoring trends, data, and the adherence to desktop and technical procedures with the objective of ensuring compliance of Centers For Medicare and Medicaid Services (CMS), Department Of Health Care Services (DHCS), Covered California, other State and Federal regulatory requirements, and L.A. Care's Regulatory Affairs & Compliance Department as applicable to L.A. Care's product lines. This position will maintain a base knowledge of the benefits and eligibility requirements for all product lines, Medi-Cal and Medicare Marketing Guidelines as well as the organization's and the department's established policies and procedures. This position will also assist in the development of tools and procedures established to monitor the performance for both the Enrollment Support Services team and the Health Plan Representatives team against the department's established standards, key performance indicators, best practices, and processes and makes recommendations for individual and group training/retraining and process improvements. This position will have the ability to identify coaching opportunities for the Field Sales Representatives on the various marketing presentations on the different lines of business to ensure communication is delivered within compliance standards. Assist in the development of training materials and delivery to various audiences in order to maximize opportunities for membership growth.
Demonstrates a complete and thorough knowledge of policies and procedures to ensure compliance. Assists with developing, documenting, and updating processing procedures as needed. Ensures compliance of CMS, DHCS, Covered California and other State and Federal regulatory requirements by conducting internal audits and review of calls; ensures department CRM records are documented accurately and timely in accordance with departmental standards. Audits representatives' inbound and outbound phone calls and/or correspondence, observing performance, techniques, and application of guidelines and procedures. Verifies that representatives are providing up-to-date information, following current processes, and communicating effectively to callers. Coordinates with department Team Leaders and Managers to ensure appropriate number of audits is performed for each representative and to ensure representatives' availability during audit periods. Evaluates and records the quality and performance. Summarizes findings and recommendations and forwards to supervisor to use in performance assessments and promotional decisions. Provides critical data used to generate weekly or monthly reports on the performance of representatives. Participates in meetings and presentations or other designated special projects as assigned by department management. Maintains a comprehensive working knowledge of polices, procedure, and benefits across all product lines.
Analyzes quality of performance and identifies deficiencies in skills and assists in the development of quality tools and procedures to continuously improve quality of customer service and documentation. Monitor errors to identify trends that may reveal training deficiencies, processing flaws, or individual performance challenges. Perform field marketing evaluations for the Health Plan Field Representative to ensure that presentations are delivered accurately and within compliance.
Performs routine assessments with new hires and established Enrollment Support Services and Health Plan Field Representatives in need of quality improvement. Assessments involve, but are not limited to, reviewing calls, documentation and record keeping, coaching, field marketing presentation evaluations with our contracted providers, prospects and marketing events. Duties include assisting in making recommendations for Desktop and Technical Procedures for training purposes.
Generates daily, weekly, and monthly reports on call metrics and evaluations to be reviewed by management; evaluates a minimum number of calls as set by management; maintains a high-level of quality standard when evaluating calls and documentation in CRM. Field marketing evaluations to be conducted and reported to the Sales Training Manager in conjunction with the Manager of Enrollment Support Services and Field Sales Manager on a quarterly basis or on a corrective action basis to ensure all necessary delivery of presentations are within compliance within all of L.A. Care lines of business.
Performs other duties as assigned.
In lieu of degree, equivalent education and/or experience may be considered.
At least 0-2 years of health care experience, preferably in Sales, Member Services or Quality Control.
Knowledge of and experience of Medi-Cal, Medicare, and Covered California; Working knowledge of a CRM, AEVS, and other benefit eligibility programs.
Good oral and written communication skills.
Strong analytical skills and attention to detail.
Strong research skills.
Intermediate knowledge of Microsoft (MS) Office.
Ability to coach and train employees.
Covered California Certification (Or must be obtained within 90 days from date of hire.)
Plan Based Enroller (PBE)
L.A. Care offers a wide range of benefits including
+ Paid Time Off (PTO)
+ Tuition Reimbursement
+ Retirement Plans
+ Medical, Dental and Vision
+ Wellness Program
+ Volunteer Time Off (VTO)