Quality Reviewer- Enrollment and Billing

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with us.
Residency in or relocation to Louisiana is preferred for all positions.
Applicants must be authorized to work for Louisiana Blue in the United States without employer-sponsored immigration support. Louisiana Blue will not provide current or future employment-based immigration sponsorship or other immigration support for this opportunity, including H-1B, L-1, O-1, H-1B1, E-3, TN, or J-1 sponsorship or F-1 OPT/STEM OPT/CPT support. Applicants who would require such sponsorship or employer support during their employment should not pursue this opportunity.
This position is hybrid.
Position Purpose
The Customer Service Quality Reviewer I is responsible for evaluating customer interactions to ensure compliance with departmental policies, business requirements, regulatory standards, and customer service expectations. This position performs quality audits of customer contacts, documents findings, documents audit findings, identifies audit-based trends, and provides objective feedback to support compliance, service consistency, and member experience. This position partners with operational leadership, trainers, and customer service staff to promote consistency, accuracy, compliance, and a positive member experience. This position is accountable for complying with all laws, regulations, and organizational policies associated with assigned responsibilities.
NATURE AND SCOPE
This position reports to the Supervisor, Operational Learning & Performance. The Customer Service Quality Reviewer I works independently while following established quality monitoring standards and procedures. The role is responsible for reviewing customer interactions, documenting audit results, identifying recurring audit trends, escalating concerns as appropriate, supporting assigned quality improvement activities, and assisting with onboarding and employee development through activities such as Connect Days and Helpline support
QUALIFICATIONS
Education
High School Diploma or equivalent is required
Associate degree preferred
Work Experience
2 years in either Enrollment & Billing, Call Center, and/or Claims analyzing transactions is required
Experience reviewing customer interactions, interpreting policies and procedures, or supporting operational quality initiatives preferred.
Skills and Abilities
Strong verbal and written communication skills
Strong organizational and analytical abilities
Ability to objectively evaluate customer interactions
Ability to maintain confidentiality and professionalism
Ability to identify trends and opportunities for improvement
Knowledge of customer service principles and quality standards
Ability to provide constructive feedback
Working knowledge of Microsoft Office applications
Ability to work independently and collaboratively
Ability to adapt to changing priorities and business needs
Basic understanding of HIPAA requirements and healthcare operations
ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS
40% - Quality Monitoring and Audit Activities
Conduct quality reviews of inbound and outbound customer interactions, including telephone calls, emails, written correspondence, and other communication channels.
Evaluate interactions for accuracy, compliance, professionalism, customer service effectiveness, and adherence to established standards.
Review customer contacts for proper authentication, documentation, and benefit accuracy.
Verify compliance with departmental policies, procedures, HIPAA requirements, and regulatory guidelines.
Complete assigned audits within established productivity and timeliness expectations.
Maintain accurate records of completed audits and supporting documentation.
20% - Audit Documentation and Reporting
Document audit findings in designated quality systems.
Ensure findings are supported by documented evidence and quality standards.
Maintain audit files and review histories for reporting purposes.
15% - Coaching and Performance Support
Provide objective and fact-based feedback through audit results.
Support trainers by identifying coaching opportunities.
Participate in side-by-side onboarding, monitoring activities for new hires when assigned.
Reinforce quality expectations and established procedures.
Assist with identifying educational opportunities for representatives.
10% - Trend Identification and Continuous Improvement
Monitor audit findings for recurring performance trends and operational concerns.
Identify audit-based trends that may indicate process gaps, training needs, or quality risks
Escalate compliance concerns, customer experience issues, and systemic risks to leadership.
Participate in quality improvement initiatives and special projects.
Share documented findings and recommendations with leadership to support service quality and member experience improvements.
10% - Calibration and Quality Consistency
Participate in calibration sessions to ensure consistency in audit scoring and interpretation.
Maintain current knowledge of quality standards and audit methodologies.
Assist with validating quality guidelines and audit tools.
Support initiatives that improve audit consistency and reliability across the department.
5% - Professional Development and Other Duties
Maintain knowledge of products, benefits, policies, procedures, and operational changes.
Complete required training and continuing education activities.
Support departmental projects and initiatives as assigned.
Perform other duties within the scope of responsibility as assigned.
Additional Accountabilities and Essential Functions
The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions
Perform other job-related duties as assigned, within your scope of responsibilities.
Job duties are performed in a normal and clean office environment with normal noise levels.
Work is predominately done while standing or sitting.
The ability to comprehend, document, calculate, visualize, and analyze are required.
An Equal Opportunity Employer
All internal employees please apply through Workday Careers.
PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI)
Additional Information
Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.
If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.
In support of our mission to improve the health and lives of Louisianians, we encourage the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.
We perform background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust a