Who we are:
Meridian, a WellCare Company, is part of a national network of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry.
We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in Michigan, Illinois, Indiana, and Ohio. As a part of the WellCare Family of companies, we deliver healthcare excellence to millions of members nationwide.
Our associates work hard, play hard, and give back. Meridian associates enjoy an exceptional experience and culture including special events, company sports teams, potlucks, Bagel Fridays, and volunteer opportunities.
A Day in the Life of a WFO Quality Team Lead:
This position is responsible for oversight of the Customer Experience and Claims Quality Assurance Auditors, with an emphasis on the quality, productivity, monitoring, and supervising of daily functions.
- Works with the Manager of Workforce Optimization to supervise and ensure expected production levels are maintained and all department Key Performance Indicators (KPIs) are met
- Works with the Team Leads to coordinate updates and education for all member, provider, claims and administrative policy changes and contractual requirements made by MHP, State, or accrediting entities
- Oversee Customer Experience Auditors to ensure quality monitoring on inbound and outbound calls are being performed, and that Auditors are meeting with staff for coaching and feedback
- Oversee Quality Assurance Auditor to ensure monitoring on processed claims is being performed, and that Auditors are meeting with staff for coaching and feedback
- Coordinate with call center vendor to ensure quality is aligned in both call centers and quality KPI’s are consistently met
- Monitors growth and development of auditing program to ensure quality monitoring is consistent throughout the department
- Monitor and reviews quality criteria to ensure accuracy for the auditing teams
- Act as liaison for external departmental leadership to relay updates and process changes
- Complete at least one process improvement project annually
- Able to resolve and triage supervisor calls
- Monitor Auditor Floor walks
- Promotes excellent customer service and positivity to members and internally to Meridian
- Understands and able to maneuver through the Meridian member handbooks
- Assist with Customer Experience call volume if needed
- May be required to work weekend (Friday-Sunday) shifts, cover holidays and/or observed holidays
- Coordinate with all departments as needed to perform job functions
- Perform other duties as assigned
What you can bring to Meridian:
- Bachelor’s degree or Fellow designation from the Academy for Healthcare Management (AHM) is required
- Must have a minimum of two years of customer service/call center experience
- One year auditing experience required
- Claims processing experience preferred
- 2+ year(s) of top performance as a non-management associate during which leadership abilities were demonstrated is preferred
- Knowledge of customer relations and team participation
- Working knowledge in Microsoft Office applications (Outlook, Word, Excel, etc.)
- Able to motivate and supervise auditing staff to meet all company and departmental goals
- Must be able to work a flexible schedule, including weekends and evenings
- Excellent supervisory skills with a strong emphasis on employee motivation, coaching, and mentoring
- Excellent verbal and written communication skills
- Organizational skills and the ability to manage multiple interrelated tasks
What Meridian can offer you:
- Our healthcare benefits include a variety of plans that are effective on the first day of employment for our new full-time team members.
- Opportunity to work with the industry’s leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities.
- Meridian offers 401k matching that is above the national average.
- Full-time Meridian employees are eligible for tuition reimbursement towards Bachelor’s or Master’s degrees.
- Meridian was named Detroit's #1 Fastest Growing Company by Crain's Magazine, so it is a great time to get involved with Meridian.
Equal Opportunity Employer