Quality Assurance Analyst

Come Grow With Us
At Gold Coast Health Plan, we are driven to create the health plan of the future - today. We are disrupting the conventions of the health care industry by creating and applying leading-edge solutions to its many challenges.

Working at Gold Coast Health Plan means working alongside a team of committed individuals who are reshaping the organization and redefining how the needs of the whole person - health, health care, and social services and supports - are met. We are seeking collaborators, innovators, and those who are driven to be their very best.

If you are looking for a career of purpose and are passionate about having an impact on society's health care challenges, then Gold Coast Health Plan is where you should be. Here, you will be challenged and rewarded in equal measure.

About this role:

Reasonable Accommodations Statement
To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

ESSENTIAL FUNCTIONS

Job Function & Responsibilities
Performance Monitoring:
* Evaluate call recordings and interactions based on NCQA, CMS and DHCS scorecard and internal quality standards.
* Ensure the required volume of calls is reviewed to meet compliance and internal targets.
* Document and report performance trends, identifying gaps and opportunities for improvement.
Coaching & Feedback:
* Provide actionable feedback to agents to enhance their performance and ensure service standards are met.
* Facilitate 1:1 coaching sessions or assist supervisors in delivering performance feedback.
* Participate in team calibration sessions to align on scoring consistency and ensure fairness across evaluations.
Dispute Resolution:
* Participate in the agent score dispute process to address discrepancies in performance assessments.
* Collaborate with supervisors and agents to resolve disputes and maintain transparency.
Collaboration & Reporting:
* Partner with Contact Center leadership to identify trends and recommend process improvements.
* Provide regular reporting on QA performance metrics to management.
* Collaborate with the training and operations teams to ensure feedback is integrated into training programs.

MINIMUM QUALIFICATIONS
Education & Experience:
* High School Graduate or General Education Degree (GED)
* 2-3 years of experience in a quality assurance role within a contact center environment.

KNOWLEDGE, SKILLS & ABILITIES
Preferred Qualifications:
* Bachelor's degree or equivalent work experience in a related field
* Experience working with healthcare plans or regulated industries preferred.
* Equivalent In lieu of degree: Will accept 4 years of experience in any combination of academic education, professional training, or work experience, which demonstrates the ability to perform the duties of the position.
* Experience within healthcare, insurance, or other regulated industries preferred.
* Familiarity with DHCS scorecards and compliance standards a plus.

Technology & Software Skills: Advanced computer skills in MS Office products.

Certifications & Licenses: A valid and current Driver's License, and Auto Insurance

Competency Statements
* Business Acumen - Ability to grasp and understand business concepts and issues.
* Management Skills - Ability to organize and direct oneself and effectively supervise others
* Decision Making - Ability to make critical decisions while following company procedures.
* Goal Oriented - Ability to focus on a goal and obtain a pre-determined result.
* Interpersonal - Ability to get along well with a variety of personalities and individuals.
* Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.
* Time Management - Ability to utilize the available time to organize and complete work within given deadlines.
* Relationship Building - Ability to effectively build relationships with customers and co-workers.
* Presentation Skills - Ability to effectively present information publicly.
* Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.
* Judgment - The ability to formulate a sound decision using the available information.
* Communication, Oral - Ability to communicate effectively with others using the spoken word.
* Communication, Written - Ability to communicate in writing clearly and concisely.
* Problem Solving - Ability to find a solution for or to deal proactively with work-related problems.

PHYSICAL DEMANDS

O (Occasionally) Position requires this activity up to 33% of the time (0 - 2.5+ hrs/day)
F (Frequently) Position requires this activity from 33% - 66% of the time (2.5 - 5.5+ hrs/day)
C (Constantly) Position requires this activity more than 66% of the time (5.5+ hrs/day)

Stand O
Walk F
Sit C
Manually Manipulate C
Reach Outward O
Grasp F
Lift 10 -20lbs O
Carry 10-20lbs O

The estimated pay range for the position is:

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in.