Quality Specialist II

🔥 1 minute ago

🗽 New York – Remote

🗽 New York – Remote

💵 $23 - $39 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Maintain comprehensive working knowledge of policies, procedures and services • Ensure appropriate customer service levels and accuracy and quality standards • Lead and/or participate in continuous quality improvement initiatives • Serve as a resource regarding quality concerns and quality matters • Perform quality reviews of complex claims and transactions • Identify and monitor trends and quality risks • Develop and execute training programs based on business needs, trends and patterns • Conduct procedural and quality reviews/audits 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 and processing errors • Develop work plans and processes • Provide training and coaching for new and existing employees • Perform other duties as assigned

🎯 Requirements

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future • 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 • Experience in credentialing and/or provider data preferred • Knowledge of Fidelis Care preferred • Bi-lingual skills may be preferred depending on the state • 10% travel may be required • Complies with all policies and standards

🏖️ Benefits

• Health insurance • 401K • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Competitive pay • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity

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