Aetna Quality Assurance Specialist in Greenville, South Carolina

Req ID: 48995BR

Candidate must work from one of the following office locations: Tallahassee, FL, Cary, NC, Greenville, SC, Daleville, IN


Monitors and evaluates the quality and handling of inbound calls, outbound calls and/ or correspondence, and documents quality and productivity issues and performance measures for management review. Provides information to assist in the feedback and formal education process of call center staff.

Fundamental Components:

The position of Call Quality Assurance Specialist main responsibility will entail providing coaching to Medicare Customer Service Representatives. The position requires coaching customer service staff on work procedures including but not limited to proper call handling and maintaining call quality standards. The CQAS will provide on-going feedback and act as a subject matter expert in addressing procedural issues. In addition, the Call Quality Assurance Specialist will provide technical and subject matter expertise relative to policies, procedures, and customer service applications/systems tools. The Call Quality Assurance Specialist will utilize available software/hardware applications promoting reinforcement coaching for staff, identify developing trends impacting service levels and proactively partner with appropriate parties to recommend process enhancements or solutions to avoid potential service delivery problems, Through these coaching efforts the Call Quality Assurance Specialist will aide in improving overall call quality, first call resolution and the customer experience. The position does require periodic handling of inbound member calls.


In depth knowledge of Medicare Customer Service Call Center is required

Medicare specific policies and procedures knowledge required

IDX and/or ASD experience required

Complaint and Appeal Tracking System required

CTI Screen Pop required


The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.


Functional - Customer Service/Customer Service - Member Services - HMO products/1-3 Years

Functional - Customer Service/Customer Service - Call Quality Audit - Inbound call monitoring/1-3 Years

Functional - Products-Medical/All Individual Medicare Plans/1-3 Years


Technical - Aetna Applications/Aetna Strategic Data Warehouse/1-3 Years/End User

Technical - Aetna Applications/Complaints & Appeals Tracking System/1-3 Years/End User

Technical - Aetna Applications/CTI Screen Pop-up/1-3 Years/End User

Technical - Aetna Applications/Customer Service HMO/1-3 Years/End User


General Business/Maximizing Work Practices/ADVANCED

Leadership/Collaborating for Results/FOUNDATION

Leadership/Engaging and Developing People/ADVANCED


General Business/Communicating for Impact/ADVANCED

Service/Creating a Differentiated Service Experience/ADVANCED

Service/Working Across Boundaries/ADVANCED


Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Customer Service