Health Services QA Analyst

Department: Health Fund

Reports to: Manager of Health Services

Summary

The 32BJ Health Fund is a multiemployer labor management fund that provides health benefits to members of SEIU Local 32BJ and their dependents. The Fund is self-insured and responsible for efficiently managing its resources as it provides comprehensive coverage for approximately 200,000 people across multiple states and Washington, DC. The Fund offers benefits for medical, hospital, prescription drug, vision, dental, short- and long-term disability, and life insurance. The Health Fund is one of five benefit funds administered by the 32BJ Benefit Funds.

To ensure that it can deliver cost-effective, high-quality care, the Fund has embraced value-based plan design and innovative purchasing strategies that encourage participants to use healthcare models and programs that provide primary care and other cost-effective benefits, including the 32BJ Maternity Program and the 32BJ Health Fund Centers of Excellence for Joint Replacement and Weight Loss (Bariatric) Surgery. The Fund operationalizes this strategy by actively managing its plans and provider networks and by investing in forward-looking policies that lower healthcare costs while maintaining quality of care.

The 32BJ Health Fund seeks a Quality Assurance Analyst to provide technical assessments of member calls and notations in our corporate systems made by Health Services staff, including but not limited to the Patient Advocates (PA) and the Patient Coordinator. The Quality Assurance Analyst will perform concurrent monitoring and assessment of phone calls, perform quality control on notes, and produce reports on audits, noting trends and making recommendations for improvement/change. Additionally, the Quality Assurance Analyst will identify workflow deficiencies and report them to the Health Services Manager and Supervisor, conduct telephonic member surveys on program participation, as well as perform other duties and work for special projects as assigned by management.

Essential Duties and Responsibilities

As the Health Fund team is evolving, so is the role of the Quality Assurance Analyst. The responsibilities of this position include, but are not limited to:

• Perform concurrent monitoring/assessment and scoring of phone calls between 32BJ members and PA’s to determine the accuracy of the PA’s response, professionalism, timeliness, telephone presentation skills, and the level of responsiveness provided by the PA towards the member.
• Perform quality control on the timelessness and accuracy of the PA’s documentation in Microsoft Dynamics, vendor systems, and internal systems to ensure corporate standards were observed and that the notes coordinate with what occurred during the member call.
• Identify deficiencies, investigate and determine the reasons for errors, develop recommendations, and produce reports on findings for review with management.
• Identify training needs for PA and advise management of what to address with individual PA’s.
• Provide feedback to management of any trends and prevalent processing errors that indicate a system problem.
• Identify exceptional PA’s performance and recommend employee recognition when appropriate.
• Conduct telephonic surveys on Health Fund programs in a timely manner:
• Perform other duties as requested by Management.

Skills, Qualifications and Core Competencies

• Is able to work both independently and collaboratively.
• Demonstrates attention to detail, quality, and consistency.
• Outstanding written and oral communication and interpersonal skills.
• Must possess superior ability to provide constructive support and promote positive morale.
• Expert knowledge of member call and note taking requirements.
• Expert knowledge of internal corporate systems (Dynamics, Cisco & V3), the benefits offered by the Fund, and Health Services standard operating procedures.
• Must be able to maintain the highest level of confidentiality and high credibility when assessing customer care protocols.
• Embraces the mission, purpose, and vision of the 32BJ Health Fund

• Mission: To improve the lives of hard-working people by providing sustained access to affordable, high-quality healthcare
• Purpose: To maximize the value of our healthcare dollars so that members and employers have the flexibility to allocate resources to other critical needs
• Vision: To create a more just society by making access to quality health services easy and affordable

Education

• High school diploma or equivalent degree required
• Associate degree or equivalent work experience in the healthcare industry preferred

Language Skills: Speak, read, write, and understand English & Spanish required

Reasoning Ability: High

Certificates, Licenses, Registrations: None required