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.Job SummaryThe Customer Solution Center Quality Assurance Analyst II will be responsible for coordination and monitoring of Quality Monitoring reporting and data output. The Analyst will have a keen and innovative focus on continuous quality refinement across all product lines, with a strong emphasis on adherence to regulatory standards while ensuring customer satisfaction. This will be done through collaboration with internal stakeholders in ensuring required measures are being followed and opportunities for improvement are being addressed. The Analyst will be directly responsible for identification of inefficiencies and gaps in processes to enhance the customer experience and increase first call resolution. This Analyst will develop and maintain a successful oversight strategy to ensure work order accuracy and performance deficiencies are addressed in a timely and effective manner.DutiesDevises plan(s) for success that showcase current strengths and redresses existing weaknesses.Manages data, reporting, and information flow between Quality Monitoring and Call Center.Utilizes data output and reporting to identify, and analyze trends, root causes and recommends opportunities for process and/ or training curriculum improvement.Partners with call center management at all regulatory audits, and assists with the design of any associated remediation efforts by exploring innovative ideas of approach and direction.Conducts tracking and trending of Customer Service Representative (CSR) call quality data to assist team supervisors with catering coaching techniques to trends identified.Directs involvement with creation and updates to Desk Level Procedures to ensure alignment with regulatory standards.Leads root-case analysis efforts to identify and mitigate risks within the call handling procedures.Prepares monthly executive summaries for management that highlight performance and call trends.Performs other duties as assigned.Education RequiredAssociate’s Degree in Healthcare Related FieldIn lieu of degree, equivalent education and/or experience may be considered.Education PreferredBachelor’s DegreeExperienceRequired:A minimum of 4 years call center experience.At least 2 years of healthcare experience.Must be highly experienced in interpreting and operationalizing complex contractual and regulatory terms.Preferred:Experience working in a Quality Auditing department strongly preferred.Experience in managing call center operations in a healthcare environment.Knowledge of and experience of Medi-Cal, Medicare, and Covered California.Working knowledge of a CRM, AEVS, and other benefit eligibility programs.SkillsRequired:Driven self-starter.Strong customer service skills.Strong analytical and troubleshooting skills; with the ability to formulate recommendations to improve quality.Proficient in MS Office applications; Word, Excel, PowerPoint.Strong relationship and rapport building.Excellent technical skills and attention to detail.Excellent communication skills; both verbal and written.Ability to adapt to fast-pace environment and constant demands.Ability to lead initiatives from beginning to end; Coaching, leadership, and people development skills.Licenses/Certifications RequiredLicenses/Certifications PreferredRequired TrainingAdditional InformationL.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)At L.A. Care, we value our team members’ safety. In order to keep our work locations safe, each employee is required to self-screen for symptoms prior to entering any L.A. Care location each day. L.A. Care and all of its staff are required to comply with all state and local masking orders. Therefore, when on-site at any L.A. Care location, employees are expected to wear a mask in areas where physical distancing cannot be managed.Nearest Major Market: Los AngelesJob Segment: Medical, Medicare, Call Center, Healthcare, Customer Service