Quality Assurance Analyst – Customer Care

Position Responsibilities

Collaborate with leadership to develop and maintain customer care quality scorecards aligned with departmental standards to evaluate agent performance

Conduct quality evaluations of recorded and live customer interactions, ensuring scoring aligns with internal Quality Assurance guidelines

Assess agent adherence to procedures, compliance procedures, service standards, and best practices to ensure effective and efficient customer support

Facilitate and participate in calibration sessions within internal teams, external partners, and clients to ensure alignment and consistency in scoring

Support Customer Satisfaction (CSAT) calibration efforts, partnering with clients and operations teams to enhance service quality

Analyze QA data and reporting to identify trends, uncover improvement opportunities, and deliver actionable insights, trends and agent opportunities

Provide performance reporting and support to supervisors and call center leadership to drive quality improvements

Identify training needs through QA evaluations; support new hire onboarding by ensuring clear understanding of quality standards and scoring expectations

Oversees the end-to-end processing of member complaints and grievances, ensuring accurate documentation, thorough investigation, and resolution within established regulatory, NCQA, and internal service standards.

Review, document, and research Authorized Representative (AOR) forms in a timely and accurate manner to support compliance and operational efficiency

Ensure timely and accurate completion of QA reporting and communication requirements

Maintain strict adherence to all company policies and regulatory requirements, including HIPAA, patient safety, and data security protocols

Provide operational support by handling inbound or outbound calls as needed to support business demands and service levels

Report any compliance concerns or policy violations promptly to management

Perform other duties as assigned by the supervisor or other members of management within the deadlines provided

Qualifications / Profile

4+ years’ experience with call center operations, with at least 2 years of experience with Quality Assurance or training

PBM or Healthcare call center operations experience preferred

Bachelor’s degree preferred, or equivalent experience• Knowledge of HIPAA and Privacy Rule regulations

Knowledge of Medicare

A self-starter with outstanding customer service skills and dedication to providing exceptional customer care in a changing, fast-paced startup environment

Demonstrate aptitude to develop processes and coach frontline customer service employees

Ability to give and receive constructive feedback

Strong analytical and organizational skills with an ability to carry out responsibilities with little or no supervision

This range represents the low and high end of the anticipated base salary range. The actual base salary will depend on several factors such as: experience, knowledge, skills, and location of the job.

Remote, US Salary Range$71,200—$112,000 USDNew York, NY Salary Range$89,600—$112,000 USDDenver, CO Salary Range$82,400—$103,000 USDAll employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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