Analyst, Operations QA

Qualifications

• Education / Degree Requirements / Certifications: Associate Degree or four years of experience required. Quality certification such as Lean Six Sigma Yellow or Green Belt is a plus.
• Experience: Two to four years of process improvement experience, including training in statistical tools/reporting and preferably Six Sigma techniques. Two to four years in a quality assurance or quality auditing role, preferably in a call center, claim operations, pharmacy hub, or similar environment.
• Knowledge: Solid working knowledge of quality-oriented services such as accuracy management, performance metrics, customer experience/satisfaction, and SOP execution. Strong background in identifying and executing process improvement opportunities and initiatives. Healthcare experience—specifically claim processing, contact center, benefit verification, case management, or similar industry experience—is required. Call center or claim processing experience is a plus.
• Skills: Prefer Lean Six Sigma certification at Yellow Belt level or higher. Strong understanding of Microsoft Office products (Excel, Word, PowerPoint, etc.). Excellent verbal and written communication skills to support relationships across all levels of the organization. Bilingual English/Spanish is a plus.
• Competencies: Communication (Oral & Written), Analytical & Logical Reasoning, Decision Quality, Process Knowledge.

Responsibilities

• Perform data analysis on data collected by Quality Associates to identify trends, insights, and areas of opportunity within programs and agent performance.
• Create slide decks and present these documents to internal and external stakeholders alongside Operations Quality Assurance leadership.
• Use the data to recommend process improvement opportunities and lead teams toward action-oriented results.
• Lead meetings with Operations leadership and clients to discuss program quality scores and areas of opportunity.
• Communicate identified trends and quality risks, serve as a resource regarding quality concerns, and continue monitoring for improvement opportunities.
• Provide feedback to Operations Leadership and Operations Agents during coaching sessions, utilizing structured coaching methods.
• Explore process improvement opportunities, initiatives, and remediation. Coach Operations Quality Associates as needed through peer-to-peer coaching.
• Train new department hires and operations agents on program business rules and processes.
• Complete evaluations on work completed by Operations Agents to ensure adherence to documented business rules, SOPs, WINs, and compliance standards, while ensuring all transactions support the CRx values of exceptional customer service for patients, healthcare providers, and customers.
• Other duties as assigned.