Leads the development, execution, and continuous enhancement of the customer experience QA program. Creates and maintains QA scorecards, evaluation criteria, scripts, and standards aligned with health plan policies and regulatory requirements. Conducts regular calibrations with supervisors and operational leadership to ensure scoring consistency and fairness. Evaluates all forms of member interactions for accuracy, empathy, compliance, and resolution quality.
Monitors and interprets trends in member experience metrics, including CAHPS, satisfaction surveys, complaints, and grievance themes. Identifies root causes of negative member experiences and recommends targeted solutions. Leads initiatives that improve first call resolution, member education, clarity of communication, and service recovery effectiveness. Supports culturally sensitive and health-literate communication practices across customer experience service teams.
Works closely with customer experience leadership to provide recommendations for process improvements, workflow optimization, and service protocols. Tracks performance outcomes and collaborates on coaching plans for teams and individuals. Provides timely feedback to supervisors and frontline staff to reinforce excellence and correct deficiencies.
Partners with Training/Learning and Development to design onboarding and ongoing training aligned with QA findings. Ensures training content reflects service expectations, regulatory updates, and quality standards. Facilitates QA refresher sessions, coaching workshops, and service excellence training as needed.
Prepares QA documentation and evidence for regulatory reviews, internal audits, and accreditation surveys. Supports the development and monitoring of corrective action plans when compliance issues arise.
Develops and maintains dashboards and reports that track QA outcomes, experience trends, and service performance. Presents insights to leadership, identifying risks, opportunities, and actionable recommendations. Monitors Key Performance Indicators (KPIs) such as call accuracy, empathy quality, service level impact, error rates, and first call resolution.
Partners cross-functionally to align on experience strategy. Participate in cross-functional initiatives to improve end-to-end customer experience and streamline the member journey. Serves as a subject matter expert on service quality, customer engagement, and experience-driven best practices.
Conducts development planning. Fosters a culture of accountability, team collaboration, and service excellence.
Manage staff , including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.
Manages complex projects, engaging and updating key stakeholders, developing timelines, leads others to complete deliverables on time and ensures implementation upon approval.
Responsible for reporting, budgeting, and policy implementation.
Performs other duties as assigned.