Manager, Customer Engagement and Experience Quality Assurance

Job Summary

The Manager of Customer Engagement and Experience Quality Assurance (QA) is responsible for leading quality oversight, service excellence, and member experience improvement activities within the health plan’s customer experience operations. This position ensures that customer service cross functional teams deliver accurate, high-quality, culturally competent support to members.

The Manager oversees QA reviews, conducts experience analytics, guides service improvement initiatives, and partners with operational leaders to strengthen performance tied to Consumer Assessment of Healthcare Providers and Systems (CAHPS), STARS, Centers for Medicare and Medicaid Services (CMS)/State requirements, and organizational service standards.

The Manager is also responsible for effectively representing the department and the organization for various audits, initiatives, etc. and facilitating and/or providing technical expertise and support for various cross-functional meetings, task forces, and committees.

The Manager manages all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports. Participates and make recommendation on the department's strategic planning and/or long-term decision-making.

Duties

Leads the development, execution, and continuous enhancement of the customer experience QA program. Creates and maintains QA scorecards, evaluation criteria, scripts, and standards aligned with health plan policies and regulatory requirements. Conducts regular calibrations with supervisors and operational leadership to ensure scoring consistency and fairness. Evaluates all forms of member interactions for accuracy, empathy, compliance, and resolution quality.

Monitors and interprets trends in member experience metrics, including CAHPS, satisfaction surveys, complaints, and grievance themes. Identifies root causes of negative member experiences and recommends targeted solutions. Leads initiatives that improve first call resolution, member education, clarity of communication, and service recovery effectiveness. Supports culturally sensitive and health-literate communication practices across customer experience service teams.

Works closely with customer experience leadership to provide recommendations for process improvements, workflow optimization, and service protocols. Tracks performance outcomes and collaborates on coaching plans for teams and individuals. Provides timely feedback to supervisors and frontline staff to reinforce excellence and correct deficiencies.

Partners with Training/Learning and Development to design onboarding and ongoing training aligned with QA findings. Ensures training content reflects service expectations, regulatory updates, and quality standards. Facilitates QA refresher sessions, coaching workshops, and service excellence training as needed.

Prepares QA documentation and evidence for regulatory reviews, internal audits, and accreditation surveys. Supports the development and monitoring of corrective action plans when compliance issues arise.

Develops and maintains dashboards and reports that track QA outcomes, experience trends, and service performance. Presents insights to leadership, identifying risks, opportunities, and actionable recommendations. Monitors Key Performance Indicators (KPIs) such as call accuracy, empathy quality, service level impact, error rates, and first call resolution.

Partners cross-functionally to align on experience strategy. Participate in cross-functional initiatives to improve end-to-end customer experience and streamline the member journey. Serves as a subject matter expert on service quality, customer engagement, and experience-driven best practices.

 Conducts development planning. Fosters a culture of accountability, team collaboration, and service excellence.

Manage staff , including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.

Manages complex projects, engaging and updating key stakeholders, developing timelines, leads others to complete deliverables on time and ensures implementation upon approval.

Responsible for reporting, budgeting, and policy implementation.

Performs other duties as assigned.

Duties Continued

Education Required

Education Preferred

Experience

Required:

At least 4 years of experience in customer service operations within a health plan or healthcare environment.

At least 3 years of experience in leading, supervising and/or managing staff.

Equivalency:  Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.

At least 3 years of experience in quality assurance, customer experience, or service excellence.

Experience leading teams, projects, initiatives, or cross-functional groups.

Preferred:

Prior exposure to CAHPS improvement, health plan call center metrics, and service audits highly preferred.

Skills

Required:

Strong understanding of health plan operations, benefits, and regulatory standards.

Excellent analytical, quality auditing, and reporting skills.

Ability to translate data into insights and actionable performance improvements.

Exceptional communication, coaching, and facilitation skills.

Strong leadership skills and ability to motivate and support teams.

Knowledge of service quality frameworks, root-cause analysis, and continuous improvement methodologies (e.g., Lean/Six Sigma) is a plus.

High attention to detail and organizational skills.

Proficiency in MS suite.

Strong interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment. Ability to guide and support team members.

Excellent ability to set clear goals, develop strategic plans to achieve those goals, and inspire others to work towards a shared vision.

Skilled in mediating disputes and resolving conflicts in a fair and constructive manner.

Must have a deep understanding of financial principles. Ability and excellent knowledge in developing and managing budgets, forecasting future financial outcomes, and making informed decisions about resource allocation.

Demonstrated ability to make informed decisions.

Strong verbal, written communication and presentation skills.

Deep understanding of the industry, market dynamics, and organizational operations to identify opportunities and navigate challenges.

Strong ability and knowledge to analyze market trends, anticipate future changes, and develop long-term strategies that align with the company's goals.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information