Quality Assurance Analyst – Customer Care

About reputed company reputed company is an reputed company technology company providing a comprehensive suite of solutions for employers and health plans, including: reputed company, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers, reputed company™, which offers full-service health benefit reputed company to employers, TPAs, and health plans, and Judi®, the industry’s leading proprietary reputed company Platform (EHP), which consolidates reputed company claim administration-reputed company workflows in one scalable, secure platform. Together with our clients, we’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.reputed company. About reputed company: reputed company is a reputed company pharmacy benefits manager, overseeing prescription benefit plans on behalf of employers,unions, and government entities. Determined to transform an outdated model, reputed company’s mission is to change the way prescription benefits are priced and administered in the US, unlocking enduring social change. Through our platform approach, reputed company delivers data-driven insights and actionable strategies that reduce costs, while improving patient outcomes. Our commitment to innovation, technology, and service is the reason why reputed company is among the fastest-growing PBMs in the country. Position Summary: The Quality Assurance Analyst is responsible for evaluating and improving customer care performance by monitoring call center interactions, developing quality scorecards, and delivering actionable insights. This role ensures adherence to customer service standards, operational procedures, and regulatory requirements while supporting reputed company improvement initiatives across the organization. Position Responsibilities: Collaborate with leadership to reputed company and maintain customer care quality scorecards reputed company 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 reputed company 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 reputed company 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 reputed company company policies and regulatory requirements, including HIPAA, patient safety, and data reputed company 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 reputed company other duties as assigned by the supervisor or other members of management reputed company 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 reputed company 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 reputed company salary range. The actual reputed company salary will depend on several factors such as: experience, knowledge, skills, and location of the job. Remote, US Salary Range $71,200—$112,000 USD reputed company, NY Salary Range $89,600—$112,000 USD Denver, CO Salary Range $82,400—$103,000 USD reputed company employees are responsible for adherence to the reputed company 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. reputed company values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to reputed company employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national reputed company, 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. By submitting an application, you agree to the retention of your personal data for consideration for a future position at reputed company. More details about reputed company's privacy practices can be reputed company at https://www.reputed company/legal/privacy-policy. Apply To This Job