It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Operations Quality and Training Specialist is dynamic position that is focused on ensuring our newly hired employees are accurate in processing from the beginning of their employment. This position is responsible for validating employees' outputs in various areas including Claims, Customer Care and Enrollment to ensure quality, accuracy, and regulatory compliance. The Quality and Training Specialist is most often a training classroom environment and will require at times classroom facilitation and ongoing coaching.

Our Investment in You:

• Full-time remote work
• Competitive salaries
• Excellent benefits

Key Functions/Responsibilities:

• Perform quality audits on Health Plan Operations areas for accuracy and timeliness in accordance with regulatory standards and regulatory agencies
• Coordinates with the Trainers to provide ongoing feedback to staff regarding identified performance issues and coaching opportunities
• Tracks daily evaluation completion and provides any trainee coaching that is needed
• Executes mock calls or examples scenarios for training class and then providing guidance and coaching to further learners understanding. Utilizing quality audit scenarios that are currently trending
• Live monitoring of training to ensure accurate training is taking place. Suggest improvements to documentation to ensure accurate process are followed
• Conducts staff one-on-ones and coaching as needed for performance improvement
• Participates in call calibration with Quality team, to help identify areas of consistency, lacking documentation, and opportunities to enhance training
• Maintains audit workload as assigned by Supervisor while being involved in training
• Works with teams and individuals on quality improvement efforts
• Assists with facilitation of training classes as needed
• Collaborates with trainers to develop new documentation and material to support quality initiatives and to improve accuracy
• Performs weekly coaching with trainees and existing employees
• Provides feedback to staff, team leaders and managers
• Prepares and analyzes internal and external quality reports for management staff review
• Recommends and assists in the creation quality policies and procedures
• Provides suggestions on new and existing process documentation and materials to support quality initiatives and to improve overall performance and compliance across the Operations teams
• Maintains a comprehensive understanding of appropriate departmental policies and procedures and audit specification

Qualifications:

Education Required:

• Bachelor’s degree in Business Administration, Education, related field, or an equivalent combination of education, training and experience is required

Experience Required:

• A minimum of 1 year of customer service and or/call center experience or equivalent experience is required

Preferred/Desirable:

• Previous healthcare work experience required

Competencies, Skills, and Attributes:

• Ability to facilitate training in a virtual classroom
• Strong interpersonal communication and relational skills
• Must be able to work collaboratively and cooperatively as a team member
• Ability to synthesize and process complex information and deliver the information both verbally and in writing in a clear, concise and articulate manner
• Highly organized, detail oriented and self-directed with the ability to work independently and in team settings
• Demonstrated competency with MS Office and MS Windows, specifically in Microsoft Excel
• Excellent analytical, oral, verbal, and written communication skills and customer service skills
• Must be able to multi-task, prioritize projects and work well with deadlines
• Must be flexible and willing to perform all necessary and appropriate duties to ensure the attainment of departmental and organizational goals
• Requires the ability to balance multiple priorities and function in a complex, rapidly changing environment

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 440,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded 25 years ago, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.

• WellSense will require proof of COVID-19 vaccination(s) as a term of employment for all employees. The company may make exceptions to this requirement in certain limited circumstances for religious or medical purposes.