Quality Program Specialist

Quality Program Specialist

The Quality Program Specialist is responsible for ensuring quality standards are compliant with customer requirements and consistent with company standards through quality audit processes and regular reporting. This role supports quality assurance through triage, escalation management, cause analysis, and collaboration with cross-functional teams.

• Perform quality audits on processes.
• Triage issues to appropriate teams based on complexity and urgency.
• Ensure consistent and accurate documentation and process execution.
• Escalate and manage issues, ensuring timely resolution and stakeholder communication.
• Collaborate with internal departments (e.g. Referral Management, Network development, Network Billing, Account Management, Network Services, IT) to resolve complex problems.
• Act as a liaison between internal teams and external when needed.
• Lead monthly reporting of KPIs, document findings, and contribute to continuous process improvement initiatives.

Duties and Responsibilities

• Quality Assurance and Input Management:
  • Perform quality audits on processes.
  • Triage issues to appropriate teams based on complexity and urgency.
  • Ensure consistent and accurate documentation and process execution.
  • Escalate and manage issues, ensuring timely resolution and stakeholder communication.
  • Collaborate with internal departments (e.g. Referral Management, Network development, Network Billing, Account Management, Network Services, IT) to resolve complex problems.
  • Act as a liaison between internal teams and external when needed.
• Root Cause Analysis and Continuous Improvement:
  • Conduct monthly root cause analysis of recurring issues and escalations.
  • Identify patterns and trends to inform Management.
  • Recommend and support implementation of corrective actions and preventive measures.
• Reporting and Documentation:
  • Develop and maintain reports for KPIs, audit results, and process metrics.
  • Present findings to management and contribute to continuous improvement.
  • Maintain documentation of audit, procedures, training materials, and process workflows.
  • Maintain reliable and predictable attendance during scheduled work hours.

Qualification Requirements

• Bachelor’s degree or equivalent work experience.
• 2–4 years of experience in process improvement, operations analysis, or quality improvement.
• Strong analytical and problem-solving skills.
• Proficiency in MS Office, especially Excel (pivot tables, charts, formulas).
• Excellent written and verbal communication skills.
• Ability to work independently and manage multiple priorities.

Preferred Qualifications

• Experience in healthcare, workers’ compensation, or bill review operations.
• Familiarity with quality management tools (e.g., root cause analysis, PDCA, Pareto charts).
• Certification in Six Sigma, Lean, or ASQ.

Benefits

• Health and wellness: PPO, HDHP, and HMO health insurance options with Cigna and Kaiser (CA employees only).
• Financial incentives: Competitive salaries, 401(k) matching contributions, employer-paid life and disability insurance, flexible spending and commuter accounts, and employer-matched HSA contributions.
• Vacation: Paid time off and personal holiday programs.
• Volunteer time: One paid day per calendar year.
• Learning and development: LEAP program.

About the Role

Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has an exceptional track record of generating the very best outcomes for patients, payers, and providers. Deep clinical expertise is the foundation for every part of Paradigm’s business: risk-based clinical solutions, case management, specialty networks, home health, shared decision support, and payment integrity programs. We’re proud to be recognized—again! For the fourth year in a row, we’ve been certified by Great Place to Work®, and for the third consecutive year, we’ve earned a spot on Fortune's Best Workplaces in Health Care™ list. These honors reflect our unwavering commitment to fostering a positive, inclusive, and employee-centric culture where people thrive.