Customer Engagement and Experience Compliance and Quality Auditor II
L.A. Care Health Plan
full-time
Posted on:
Location Type: Office
Location: Los Angeles • California • United States
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Salary
💰 $55,245 - $82,867 per year
About the role
- Evaluates customer interactions across all channels (calls, chat, email, and correspondence) for accuracy, professionalism, empathy, and service quality.
- Verifies representatives provide correct benefit information, follow call scripts, and use approved language.
- Reviews documentation to ensure complete, timely, and accurate recording of member interactions.
- Audits customer interaction records to ensure adherence to CMS guidelines, state Medicaid rules, NCQA standards, HIPAA, privacy regulations, and internal compliance policies.
- Identifies potential compliance risks such as benefit misinterpretations, incomplete disclosures, or policy deviations.
- Prepares detailed audit reports summarizing findings, trends, error types, and opportunities for improvement.
- Tracks performance results at the individual, team, and process level.
- Presents audit insights to leadership.
- Participates in Root Cause Analysis (RCA) for recurring quality issues, compliance gaps, or service failures.
- Collaborates with internal teams to develop and implement corrective actions.
Requirements
- At least 2 years of experience in health plan operations, contact center quality assurance, compliance auditing, or member services.
- Experience in managed care customer service or contact center environments.
- Strong knowledge of health plan benefits, customer service workflows, and contact center operations.
- Familiarity with CMS call monitoring guidelines and regulatory requirements.
- Excellent attention to detail and ability to identify compliance and quality issues.
- Strong critical thinking, analytical, and documentation skills.
- Excellent communication skills, with ability to deliver constructive feedback.
- Proficient in QA platforms, CRM systems, and call monitoring tools.
- Ability to maintain confidentiality and adhere to HIPAA/privacy standards.
- Proficient in MS Office.
- Ability to coach and train employees.
- Bilingual in one of L.A. Care Health Plan’s threshold languages is highly desirable.
Benefits
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
compliance auditingquality assurancehealth plan operationscustomer service workflowscall monitoringdocumentation skillscritical thinkinganalytical skillscoachingbilingual
Soft skills
attention to detailcommunication skillsability to deliver feedbackcollaborationempathy