Hours:

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Weekend Requirements:

On-Call Required:

Hourly Pay Range (Minimum - Midpoint - Maximum):

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant's years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

What You Will Do
Develops and coordinates the training system to include the design and successful delivery of instructional materials, training manuals, and training schedules. Trains all new and existing employees. Prepares and issues regular reports of training activities and the effectiveness of the training initiatives. Maintains updated knowledgebase, reference materials, guides, supplemental information and tools. Supports leadership in the development and management of a quality audit program including audit benchmarks, thresholds and performance measurements. Implements comprehensive audit schedule and maintains compliance documentation. Serves as a resource to other departments on training, auditing, and resource development.

Required Qualifications

• H.S. Diploma or Equivalent
• Training experience.
• Experience with training/adult education.

Preferred Qualifications

• Bachelor's Degree in related field.
• Experience in health care or managed care environment.
• Relevant experience in a call center operations/management.

Essential Functions

• Coordinates quality monitoring program
  Assists in the development and management of a quality audit system including the development of audit benchmarks, thresholds and performance measurements.
  Develops audit methodologies, testing, validation and reporting to track and trend audit initiatives and compliance.
  Maintains comprehensive audit schedule and compliance documentation.
  Ensures audit observations are clearly communicated, understood and addressed in a timely manner.
  Makes recommendations to Customer Care Supervisor and Manager for individual and departmental areas of improvement.
  Provides training support and quality monitoring to contracted after hours call center staff.
• Customer service
  Provides prompt, accurate and excellent services to internal and external customers. Develops solid professional working relationships with various internal departments and units, and as required, vendors, providers, employers, brokers, and/or other customers.
• Develop and implement
  Conducts needs analysis and assessment to determine departmental and individual training and developmental needs.
  Establishes and oversees the internal training performance system to include the design and successful delivery of instructional materials, training manuals, policies and procedures, and training schedules.
  Trains all new and existing employees in effective customer service and call center operations.
  Prepares and issues regular reports to analyze customer service training activities and the effectiveness of the training initiatives.
  Leverages alternative training methods to increase departmental efficiencies while reducing costs.
• Develop and maintain
  Develops reference materials, guides, supplemental information and tools to assist Customer Care (and, as applicable, other Operations staff members) in providing excellent customer service.
  Establishes and maintains process for regular updates of reference materials.
  Identifies opportunities to improve ease-of-use for reference materials.
• General support
  Participates in special projects and other duties as assigned. These may include, but are not limited to, work groups, proposals, audits and back-up support for other departments.
• Resource management
  Maintains working knowledge of tools and resources required to meet department needs, including but not limited to:
  Plan products, premiums, and benefits;
  IDX system modules for Registration, Enrollment, Customer Service, Referrals/Utilization Management, Premium Billing, and Claims;
  All member handbooks and benefit matrices;
  DMHC and CMS regulations;
  Claims processing guidelines;
  Coordination of benefits and third party liability;
  Cactus provider database and contracting status checklists;
  Pharmacy benefits manager enrollment/claims database;
  Knowledgebase;
  Online fax and document storage applications;
  Operational policies and procedures;
  SHP website/SharpConnect;
  Microsoft Word and Excel.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class