Quality Specialist II

Position Purpose: Maintain a comprehensive working knowledge of policies, procedures and services in order to ensure the appropriate level of customer service is delivered and/or accuracy and quality standards are met.

Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J -1, OPT, or CPT.

Preferred candidates will have experience in credentialing and/or provider data and have knowledge of Fidelis Care.

• Lead and/or participate in continuous quality improvement initiatives and serve as a resource to others regarding quality concerns

• Perform quality reviews to ensure high levels of customer service and/or accuracy in processing complex claims and transactions

• Identify and monitor trends and quality risks

• Identify, develop and execute appropriate training programs applicable to the needs of the business and based on identified trends and patterns

• Conduct procedural and quality reviews/audits to ensure adherence to policies and procedures and high levels of customer service, satisfaction and accuracy using applicable tools and technologies

• Provide written documentation to management regarding quality review/audit results

• Collaborate with cross-functional departments to identify training needs, system errors, processing errors, etc. and develop work plans and processes

• Provide training and coaching for new and existing employees

• Serve as a resource to staff regarding quality matters

• 10% travel may be required
• Performs other duties as assigned

• Complies with all policies and standards

Education/Experience: Bachelor’s degree or equivalent experience. 2+ years of combined call center and customer service experience. Previous training experience. Knowledge of insurance and/or managed care products and procedures highly preferred. Depending on the state, bi-lingual skills may be preferred.

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
 

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act