TOP Quality Consultant

Overall Purpose of the Role

The role of the Quality Consultant is to offer consulting services to key functional stakeholders, taking a datadriven approach to proactively drive quality improvements across all areas of TRICARE service delivery. They will be a practicing quality professional with good knowledge and experience in the delivery of service excellence in the healthcare, logistics or related industry. Working alongside the various service delivery teams and reporting to the Head of Program Quality, this role will support the team in achieving outstanding levels of customer satisfaction by advising on appropriate quality tools and techniques, monitoring delivery process performance and identifying areas for correction and improvement. 
 

The Quality Consultant will support all LAC platforms through their analysis and response to customer feedback. They will also analyse and act on all service-related data and develop a strong consulting relationship with functional management in order to understand and communicate service improvement initiatives. They will act as an advocate for beneficiary information security with expertise in GPDR, HIPAA and Privacy Breach procedures.
 

The Quality Practitioner will also undertake independent process and system audits internally within the team, and will provide monthly quality status reporting to the Quality Manager and to the Group Quality function using the organization’s standard templates.

Key Responsibilities

 • Identification and root cause analysis of issues impacting all LAC Contact Centers in their provision of support to beneficiaries for Claims, Enrolments, Payments, Referrals to Network or non-network care providers, or receiving Authorizations for care
• Performs daily quality audits of the Assistance Centre operations including monitoring of inbound and / or outbound telephone calls and other correspondence.
• Provides accurate and timely call quality monitoring reports on quality issues and performance measures of Contact Center operations.
• Provides feedback to managers regarding areas for improvement and recommends coaching opportunities for individual team members. May also provide feedback and coaching directly to individual team members as required.
• Performs case quality management reviews and develops action plans for individual team members and the Assistance Centre.
• Liaise with Operations Managers and the Learning and Development team to ensure team members training plans are developed and delivered appropriately.
• Coordinate and facilitate monthly call calibration sessions with the appropriate stakeholders in the Assistance Centre.
• Manage customer and client satisfaction through the Customer Feedback System including logging, monitoring and managing the service delivery.
• Prepares monthly quality reports according to department guidelines.
• Coordinate and facilitate monthly Quality, Learning & Development performance review with the operational management teams.
• Recommend policy and procedure changes or quality audit plan updates based on monitoring quality trends.
• Use benchmarking and other appropriate tools and techniques to evaluate performance and improvement priorities.
• Champion, support or lead quality improvement initiatives
• Monitor the internal and external audit schedules and standards to ensure compliance with the quality audit plan.
• Assist with special projects and other duties as assigned.
• Amalgamates evidence from data streams (CX surveys, RCA’s, audits) and performs initial analysis to identify and prioritize quality improvement initiatives
• Contributes to monitoring inboxes and tasking/logging/performing work as relevant
• Conducts client complaint investigations for the organization, including tracking, reporting and developing recommendations for complaint resolution
• High-quality written responses to customer grievances
• Develops and provides periodic compliance reports. The individual will also be responsible to analyze information and provide recommendations to management.
 

KEY PERFORMANCE INDICATORS
• Military Treatment Facility satisfaction level
• Quality targets achieved to plan
• Audit schedules on time
• Reporting accurate and timely
• Process improvements identified and actions on target
• Corrective actions implemented on time
• Development plan topical and on target 

Required Qualifications

  Required Skills and Knowledge (Brief description of technical knowledge or skills needed to perform the job)
• Lean Six Sigma certification
• Attention to detail
• Effective communication skills with an ability to communicate at various levels within the organization
• Identifies and acts on potential problems and / or difficulties. 
• Demonstrates effective problem solving skills and lateral thinking. 
• Ability to work under pressure
• Effective task prioritization and task-switching
• Ability to provide clear and concise written updates
• Demonstrate appropriate listening skills
• Demonstrate appropriate spelling and grammar
• Coaching experience desirable
 

Required Work Experience (Brief description of the job-related experience needed to perform the job)
• Minimum of 2 years’ experience as a Quality Affiliate within a customer-centric service led environment
• Knowledge or familiarity of TRICARE Overseas Program is a plus status
• Experience with process control checks and inspections required e.g. call and case reviews
• Experience with other insurer or claims processor

Required Qualifications / Certifications (Brief description of the educational background needed to perform the job)
• Bachelor’s degree or relevant work experience
• Relevant Assessors accreditation desirable
• Chartered Quality Consultant
• This position does require someone who can obtain and maintain the appropriate level of tiered investigation access for a position of Trust after being offered a position. International SOS will facilitate

Required Languages (Brief description of the language skills needed to perform the job)
• English language required

Travel / Rotation Requirements (Brief description of any travel or rotation requirements)
• This position may require travel to other TOP regions to support in audits and quality initiatives.
   

This job description outlines the types of responsibilities the incumbent is required to perform. The incumbent may be required to perform job related tasks other than those specifically presented in this job description. This job description is subject to regular review.

International SOS is an equal opportunity employer and does not discriminate against employees or job applicants on the basis of race, color, religion, gender, sexual orientation, gender identity, national origin, age, disability, genetic information, marital status, amnesty or status as a covered veteran in accordance with applicable federal, state and local laws.