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About the role

The role of the Quality Specialist is to be the primary point of investigation and response to customer feedback received across the full range of services delivered under the TRICARE benefit. These include, but are not limited to enrolments, provider selection, handling telephone calls, evacuations, issuing authorizations, and claims payments; the successful applicant will have demonstrated expertise in at least one of these areas. A broader knowledge or experience in quality improvement and root cause analysis is desired but not essential.

They will work alongside service delivery teams and will report to the Global Quality Manager. This role will support the team in achieving outstanding levels of customer satisfaction by conducting in depth forensic investigation and identifying the root cause of feedback related issue. A high quality of written responses is a requirement for this role.

The Quality Consultant will support all TRICARE platforms through their analysis and response to customer feedback. They will also analyse all service-related data in 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 Specialist role is an entry-level quality role and a great opportunity to learn Root Cause Analysis and Lean Six Sigma as well as learning key tenets of how a comprehensive Quality Management System (QMS) is structured and functions as part of a Governance framework.  Coaching and development will be provided, and it is envisaged that this role is a steppingstone to a career within quality. The applicant will be encouraged to join the Chartered Quality Institute as an Affiliate with the expectation of achieving Chartered status within 3 years.

The Quality Specialist will support all three TRICARE Regions and hence has a global remit.  

Key responsibilities

• Conducts client complaint investigations for the organization, including tracking, reporting and developing recommendations for complaint resolution
• High-quality written responses to customer grievances
• Filters all Privacy Breaches to determine if DHA escalation is required
• Works with Data Protection Officer to identify and escalate any changes in regulations that would impact existing operational models
• Conduct evacuation audits for SIN movements, amalgamate, host and present the monthly SIN Regional Evac review
• Identification and root cause analysis of issues impacting all Regional 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
• 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
• 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

About you

• Bachelor’s degree or relevant work experience
• Experience with process control checks and inspections required e.g. call and case reviews
• Knowledge or familiarity of TRICARE Overseas Program is a plus and can mitigate affiliate status
• 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
• Multi-tasking
• Ability to prioritize
• Ability to provide clear and concise written updates
• Demonstrate appropriate listening skills
• Demonstrate appropriate spelling and grammar
• This position may require travel to other TOP regions to support in audits and quality initiatives.