Claims Quality Analyst

Job Code : REQ-014824

Work@Home USA Partially Remote/Hybrid

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About Sagility

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

The purpose of this role is to promote excellent call quality, contact handling and documentation by providing an additional consistent monitoring measurement.

Job title:

Claims Quality Analyst

Job Description:

Education:

High School Graduate is required

Experience:

Min 1-2 years of experience in a call center managing the inbound calls (same experience needed in Claims process in case of back office)

Mandatory Skills:

Must be good in coaching skills (for coaching the CSR based on their call quality)
Must be proficient in typing speed
Excellent written and verbal communication skills
Excellent time management skills
Strong keyboarding/computer skills, including Microsoft Word and Excel
Must be detail oriented with good observation skills.

Roles & Responsibilities:

Remotely monitors customer service skills of all customer service representatives to ensure quality of call handling, accurate coding in CRS and making appropriate documentation.
Completes established monitoring objectives in accordance with applicable SOP?s.
Provides written and oral feedback to the CSR on all calls monitored.
Completes daily statistical reports and spreadsheets according to standard procedure.
Completes Quality Control Reports as assigned on a daily basis, makes corrections to CRS when errors exist and documents the contact.
Attends weekly and monthly department meetings to calibrate monitoring measurements.
Notifies management immediately of serious infractions in a Customer Service Representative?s call quality.
Follows all client SOP?s and applicable work related guidance documents.
Responsibilities may include taking Supervisory calls and escalations.
Ensure daily / weekly / monthly audit targets are met.
Ensure audits are completed as per client requirements and ATA is maintained.
Ensure to take calls whenever needed as specified by the manager.