Quality Assurance Officer - Unclassified

The Silver State Health Insurance Exchange (Exchange) oversees and operates the online health insurance marketplace in Nevada, known as Nevada Health Link. The Exchange is a unit within the Division of Consumer Health Services and a part of the larger department, Nevada Health Authority. The Exchange facilitates and connects eligible Nevadans who are not insured by their employer or Medicare to health insurance options.

Individuals can purchase Affordable Care Act (ACA) certified Qualified Health & Dental Plans through the Exchange and if eligible, receive subsidy assistance to help offset monthly premiums and out-of-pocket costs.

The Quality Assistance (QA) Officer is a leadership and managerial position. The position is full-time and located in Carson City
. Periodic travel in-state and out-of-state may be required.

Under the general direction of the Chief Operations Officer, the QA Officer will audit and monitor a comprehensive quality assurance program for the Exchange. The QA Officer oversees a team of program officers who handle complex consumer, carrier, broker and navigator issues. They will work with their staff to resolve Tier 3 consumer complaints from the Call Center and will be responsible for the overall consumer, broker, enrollment professionals (navigators) and call center staff’s experience when working with the Exchange.

The QA Officer will systematically review and evaluate the quality and appropriateness of call center operations, consumer care and services, identify opportunities for improvement, and work with staff to resolve issues and system deficiencies.

The QA Officer will provide technical guidance and training to Exchange staff regarding quality assurance and continuous improvement activities; ensure Exchange staff, insurance carriers, brokers and navigators are aware of consumer rights, requirements; provide training to staff, carriers, brokers, navigators, and outside agencies regarding federal and state regulations, program requirements, policies and procedures, consumer rights, consent and confidentiality issues, appeals, documentation and communication related topics, and other areas as required.

The QA Officer will develop quality assurance and continuous improvement criteria and methodology; research, coordinate, write and organize information incorporated into official corrective action plans submitted by the agency in response to survey, audit or statements of deficiencies and findings.

Under the general direction of the Chief Operations Officer, responsibilities include, but are not limited to:

• Within the QA team, identify areas for improvement, ensure written plan of action is produced, coordinate required consultation and training, and monitor completion of plan elements. Notify management of quality trends as well as service failures and successes.
• Ensure Protection of Consumer Data:
  Protect confidentiality of data by maintaining materials in secured areas in compliance with Federal and State laws and regulations and Exchange policies and procedures. Identify and report actual and potential problems to management. Monitor action plans to resolve issues. Ensure investigations and reports are reviewed and finalized within approved time frames and are conducted in a professional, objective manner.
• Provide Training on Quality Assurance:
  Provide technical assistance, educational opportunities and information to staff related to laws, statutes, regulations and standards.
• Successfully manage and supervise Quality Assurance team member(s) to include hiring, training, development, performance, coaching, accountability, and related management responsibilities. The QA Manager will supervise program officers and appeal officers in their individual programs and capacities.
• Support Call Center Operations:
  The QA Officer will review call center operations for QA issues and areas for improvement by coordinating with their team members and vendor call center staff. The QA officer will report on metrics and notify management of any concerns.
• Successfully foster and develop interstate relationships with other State Based Exchange Quality Assurance teams, call center and appeal representatives.
• Support User Acceptance Testing (UAT):
  Coordinate UAT with Exchange staff for system and call center operations.
• Oversee Exchange Appeals and Hearings:
  Supports appeal staff with resolving appeals and hearings.

Qualified applicants have the following experience or skills:

• Consumer assistance experience with public and/or private health insurance eligibility criteria and policies.
• Experience in health care policy.
• Experience working within insurance programs, including analyzing insurance regulations or policy.
• Supervisory experience and/or trainings experience.
• Experience in quality assurance or oversight of a health care and/or insurance program.
• Experience in call center operations is preferred but not required.
• Experience in system testing.