Quality Assurance Specialist jobs in Garden Grove, CA

We are currently expanding our team and looking for a Quality Assurance Specialist to join us. If you're passionate about healthcare and making a difference in people's lives, this is the job for you!

BASIC JOB PURPOSE: Quality Assurance Specialist is responsible for investigating and documenting complaints/grievances received, both internal and external, and to analyze and report trending of grievance categories.

RESPONSIBILITES/DUTIES BUT NOT LIMITED TO:

• Receive, record, and respond to complaints/grievances in a friendly and professional matter.
• As part of an investigation, completes outreach to external parties (ex. providers, facilities, members, or other parties) involved in the grievance.
• Evaluates grievance details and proposes recommendation while remaining in compliance with Call the Car policies.
• Maintains knowledge of Call the Car policies in accordance with applicable regulatory requirements and external laws.
• Acts as a liaison between Call the Car departments to coordinate information relevant to a complaint or grievance.
• Completes work within strict deadlines and escalates perceived delays to leadership.
• Writes resolution letters and corresponds with members and providers by phone and in writing.
• Ensure timely communication, follow up, review, and resolution of concerns, complaints, grievances, incidents, injuries, and accidents reported.
• Manages group email boxes, logs new cases received by email, and archives completed emails.
• Ensures all departmental goals (including, but not limited to turnaround, production expectations, and quality metrics) are met.
• Collaborates with Quality Management on Quality Assurance workplan to meet requirements.
• Identifies trends and root cause of issues; proposes solutions or escalates ongoing issues to the Lead Quality Assurance Specialist.
• Report needs for internal corrective action to Lead Quality Assurance Specialist.
• Any other duties as assigned by management.

PREFERRED QUALIFICATIONS:

• Ability to adapt to a changing environment and handle multiple priorities.
• Ability to work independently or with a team.
• Excellent problem solving, organization, multi-tasking, and time management skills.

REQUIREMENTS:

• 1-2 year(s) of relevant working experience in healthcare setting preferred.
• 1–2-year(s) call center experience in a customer service setting preferred.
• Minimum high school diploma or GED required.
• Proficiency with Microsoft Office (Word, Excel, PowerPoint, Outlook) required.
• Excellent written and verbal communication skills required.
• Must pass a Criminal Background Screening and a Drug Screen.
• Must pass government exclusion list at time of hire and monthly thereafter.

Work Location: Diamond Bar, CA. This is an onsite position.

Working Shifts: Monday – Friday, 8-hour shift between the hours of 6:00am - 5:30pm

COVID Vaccine Requirement: To ensure a safe working environment for our employees, members, and community, Call the Car requires all employees to be fully vaccinated as a term and condition of employment. Proof of COVID-19 vaccination will be required upon date of hire.

TYPICAL WORKING CONDITIONS: Office environment. May require working under stress and tight deadlines. The position requires long periods of sitting.