Quality Program Specialist - Worker's Compensation

About Our Client:The organization operates in specialty care management, focusing on improving outcomes for individuals with complex injuries and diagnoses. Since 1991, it has specialized in value-based care, delivering risk-based clinical solutions, case management, specialty networks, home health, decision support, and payment integrity programs, aiming to enhance results for patients, payers, and providers. About the Opportunity:The QUALITY PROGRAM SPECIALIST plays a critical role in ensuring adherence to quality standards through audits, data analysis, and issue resolution. This position supports initiatives to enhance operational performance and service quality, contributing to continuous improvement and the achievement of key performance indicators. Responsibilities:Conduct quality audits to verify documentation and process compliance.Triage and route issues based on complexity and urgency.Monitor adherence to quality and process standards.Manage escalated issues and communicate with stakeholders.Collaborate with cross-functional teams to resolve complex problems.Act as a liaison between internal and external parties as necessary.Perform root cause analysis on recurring issues monthly.Identify trends and recommend corrective actions.Support process improvement initiatives.Develop and maintain KPI, audit, and performance reports.Present findings and recommendations to management.Maintain documentation related to audits, procedures, and training. Requirements:Bachelor’s degree or equivalent experience.2 to 4 years in process improvement, operations analysis, or quality improvement.Strong analytical and problem-solving abilities.Proficiency with MS Office, especially Excel.Effective written and verbal communication skills.Ability to work independently and handle multiple tasks.Preferred: Experience in healthcare or workers’ compensation, knowledge of quality management tools, and certifications like Six Sigma or Lean. Pay Range and Compensation Package:The pay range and compensation package for this role will be determined based on the candidate's experience, skills, and other relevant factors. Benefits & Perks:Health insurance options including PPO, HDHP, and HMO plans.401(k) matching contributions.Employer-paid life and disability insurance.Flexible spending and commuter accounts.Employer-matched Health Savings Account contributions.Paid time off and personal holidays.One paid volunteer day per calendar year.Learning and development programs. Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin. Note:RemoteHunter is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.