Live chat
Wellcare

Quality Auditor

Wellcare - Phoenix, AZ

Quality Auditor','1803893','Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses exclusively on providing government-sponsored managed care services through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans to families, children, seniors and individuals with complex medical needs. WellCare is a Fortune 500 company, and in 2018, was recognized as a Fortune World's Most Admired Company, ranking in the top five among the health insurance and managed care industry-a testament to the hard work and dedication of the company's nearly 9,000 associates who each day live WellCare's values and deliver on its mission to help its members live better, healthier lives. The company serves approximately 4.4 million members nationwide as of Dec. 31, 2017. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, sex, age forty (40) and over, disability, veteran status, or national origin. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.','!*!

Perform quality reviews, Random Shopper Test Calls and Root Cause Analysis on Operational areas to ensure accuracy of departmental processes and identify, when needed, process improvement opportunities.

DEPARTMENT:  Provider Relations

REPORTS TO:  Director, Network Management

Location:  Phoenix, AZ

Essential Functions:

Conduct daily quality reviews of operations department processes (via random shopper test calls, agent evaluations, root cause analysis of identified opportunities, and overall analysis of customer service call handling)

Process/Document the creation and enhancement based on identified opportunities

Track and maintain quality results for appropriate distribution

Communicate audit results in a structured report format

Identify and communicate process improvement opportunities across Operational areas

Assist with special projects and other duties as assigned    ','!*!Education: 

High School Diploma or GED required; College degree preferred        

Experience: 

Minimum 2 years Customer Service experience

Special Skills (e.g. 2nd language):

Knowledge at a level usually associated with a college degree and 5 years of direct related experience

Ability to multitask (as necessary)

Ability to work in a fast paced environment with changing priorities

Ability to remain calm under pressure

Ability to sit for extended periods of time

Technical Skills/Requirements: 

Demonstrated technical expertise in performing quality reviews along with analysis of results

Knowledge of MS Outlook sufficient to communicate with internal and external contacts

Knowledge of MS Word sufficient to create simple documents such as memos and reports

Knowledge of MS Excel sufficient to create simple spreadsheets containing formatting, totals and averages, enter data into spreadsheets

Knowledge of MS PowerPoint sufficient to create simple presentations

Knowledge of additional software programs as necessary or ability to learn','US-AZ-Phoenix','2355 E Camelback Road','Suite 300','Phoenix','85016','','No','No','No','Quality Auditor

20 days

Wellcare

apply

Quality Auditor Wellcare - Phoenix, AZ, United States

   

Location: Phoenix, AZ

Company Profile:
WellCare Health Plans, Inc. focuses exclusively on providing government-sponsored managed care services, primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, to families, children, seniors and individuals with complex medical needs. The company served approximately 3.8 million members nationwide as of Sept. 30, 2015. For more information about WellCare, please review our website and view the company’s videos. WellCare has developed a full complement of expertise in three major areas of government-sponsored health care…. Medicaid, Medicare Advantage and Medicare Prescription Drug Plans. Leveraging our expertise for our members' benefit is a key part of the value we bring to our members. WellCare focuses on those members who are dually eligible for both Medicaid and Medicare. This is an area of specialization that many other health plans simply do not have. We are committed to continually improving the quality of care and service that we provide to our members. We help our members access the right care at the right time in the appropriate setting. For some members, this includes the use of coordinated care teams and community partnerships. And we’re focused on government customers and use a disciplined approach to ensure a competitive cost structure.