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Sr. QAC to assist the Quality Function on the Health Team of AFSPA

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Duties and Responsibilities
  • Appropriately service customer regarding benefits, service and medical care issues. Provide timely and accurate information to incoming calls, emails and written correspondence from customers regarding claim status and health benefits.
  • Ensure that complaints & appeals are processed in accordance with regulations, compliance standards, policies and procedures.
  • Request customer address changes, claims inquiries and portal request according to established departmental policies and procedures. Work closely with business partners to resolve customer issues
  • Identify and elevate appropriate issues to the supervisors/management staff
  • Route claims requiring an adjustment to the Plan’s administrator and ensure all relevant information needed to reach a successful outcome is provided.
  • Completely and accurately, document all interactions necessary to handle customer issues in an accurate and timely manner.
  • Reviews and assesses the work quality of the Health Team and identifies areas of concern and strength.
  • Prepares quality assurance data to be used in performance evaluations for the Health Team.
  • Provide feedback of the HBO’s quality reviews to the Health Team Supervisor regarding their individual reviews.
  • Performs administrative activities associated with maintaining accurate data on the Health Team’s quality including compiling, storing and retrieving data.
  • Handle individual and other assigned Queues in Navigator and ASD.
  • Training of staff and New Hires.
  • Conduct yourself in an appropriate manner per the code of conduct in the employee handbook (section 4)
  • Other duties as assigned
Qualifications
  • To perform this job successfully, an individual must demonstrate proficiency in the position eligible for lateral move (HBO and DBC), with an overall evaluation score of 97% or higher for one year.
  • The requirements listed below are representative of the knowledge, skill, and/or ability required.
  • Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education/Experience
  • High School Diploma or equivalent; four years of health-related customer service AND a consistent quality measurement of 98% or higher for two and half years throughout.
  • Be an AFSPA telephone HBO Senior or DBC Senior, for 1 at least year.
Apply Now

New Job 2 Title

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Duties and Responsibilities
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Qualifications
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Education/Experience
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Apply Now

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