Manager - Quality and Compliance Operations - Health Alliance Plan - Troy (full-time)

General Summary:

Manager of Quality & Compliance Operations, under the direction of the Director of Consumer and Service Excellence Strategy, is responsible for managing the customer service quality assurance, compliance monitoring, vendor management, workforce management and customer experience programs. To plan, direct, evaluate and coordinate the activities managed within the Internal Quality Auditing department of Consumer Operations, as it relates to quality initiatives, business compliance monitoring and internal and external reporting.

The position involves (a) establishing standards governing customer interactions and implements monitoring programs (b) identifying and implementing process enhancements that correct quality issues. (c) oversight and monitoring of service recovery process for issues/complaints related to feedback received from HAP members (d) oversight of vendor management activities within Consumer Operations (e) provide counseling and supervisory support to the department’s Senior Analysts, Analysts and Coordinators (f) work with training & instructional design to develop and enhance educational materials for the customer service teams.

• •Decisions are guided by functional strategies and priorities

Principal Duties and Responsibilities:

• Creates a comprehensive quality plan for each department within Consumer Operations to support the organizational goals and KPIs for the given areas. Anticipates internal and/or external business challenges/ regulatory issuesDefines program scope related to Quality Assurance, establish approach for implementation and maintain the Quality Assurance infrastructure.
• Develops a continuous improvement strategy and accountable for QA metrics for each department which focuses on improvement of service, efficiency and/or reduce overall costs
• Adapts and executes functional or departmental business plans and contributes to the development of organizational strategies
• Oversees the development of systematic approaches for assuring high quality services that meet customer needs
• Develops a communications strategy and approach to deliver communications to employees
• Defines and develops training and related reward systems
• Identifies, develops and leads key process improvement efforts and influences cross-functional efforts.
• Facilitates reoccurring ongoing client calibration sessions to ensure alignment.
• Provides feedback to various Ops Departments on common trends, gaps, and performance results. Help develop solutions aimed to improve quality performance.
• Manages scheduling of employees to ensure that audits and tasks are completed on time.
• Tracks daily, weekly and monthly performance scores related to Quality, and report the data to management. Monitor calls and internal audits, verifying accuracy; delivering team members with constructive feedback where appropriate
• Prepares reporting, dispute tracking, audit and coaching logs monthly for the leadership team
• Drives key efficiency metrics to improve team and overall operational performance (e.g. disputes, widgets per hour, accuracy, denominators, etc...)
• Ensure all policy documents are being enforced and that timely updates are completed
• Works closely with the Training team to ensure new-hires and tenured team members are receiving effective training on Quality processes.
• Develops and manages processes to perform internal process and system control testing, auditing/monitoring (real-time and retrospective) and reporting of inquiries, complaints, across all product lines to ensure compliance adherence with regulatory mandates including NCQA, Department of Labor (DOL) and Center for Medicare/Medicaid Services (CMS).
• Works closely with HAP’s Compliance Department to ensure adequate controls are in place.
• Participates in CMS Program Audits and lead Corrective Action Plan implementation.  In addition, submit Notice of Non-compliance reports to HAP’s Compliance Report.
• Manages third-party contact center provider’s quality of service and cost.
• Leads all vendor management activities within Consumer Operations. Work to ensure that vendors meet or exceed their contractual obligations by delivering quality products and services on time
• Develops and enforces monitoring program for compliance metrics and employer group specific performance guarantees. Develop compliance metrics tracking process and identify areas of improvement. Develop and complete corrective action plans along with key stakeholders to achieve required performance goals.Provides strategic oversight of internal and external workforce management and call allocation initiatives across the customer service channels. Analyzes and interprets integrated information and provides strategic analysis to improve Contact Center operational efficiency and effectiveness.
• Performs additional duties as needed