Quality Specialist

About the role

CareMetx delivers patient access solutions and support services that help patients start and stay on specialty therapy treatments. As a Quality Specialist, you will monitor and document program performance, evaluate interactions, and work with Program Operations and Quality Management to design and update quality monitoring formats and standards. You will identify coaching opportunities, assist with performance reports, and ensure adherence to compliance and customer service excellence.

Responsibilities

• Monitor interactions, support requests, and electronic records for accuracy, process adherence, and call handling standards
• Ensure interactions and support requests are executed with superior customer service
• Monitor, identify, and report adverse events, nonadherence to patient identification practices, off-label use, and provision of medical advice during interactions
• Participate in downloading and de-identifying program interactions for review
• Monitor performance quality of the program team and vendor partners
• Document evaluations using departmental quality monitoring templates, established quality standards, and quality monitoring technology
• Maintain and improve service quality by completing system, compliance, and process audits
• Work with leadership to review and resolve disputes regarding compliance scoring or standards
• Daily review of written communications (call notes, inbound SMS, voicemails) for pharmacovigilance information to validate compliance with program requirements
• Provide support and coverage for team members during unplanned and planned time off
• Participate in regular calibration meetings with QA, Training, and Operations Leadership to ensure consistency of expectations and standards
• Provide reports to management periodically
• Proactively identify trends based on quality evaluations and provide performance feedback to program Operations leadership
• Contribute to the design and enhancement of quality monitoring forms and quality standards
• Update job knowledge by studying trends, participating in educational opportunities, reading professional publications, and maintaining personal networks
• Research new technologies and methodologies in contact center QA monitoring and present findings
• Maintain regular and reliable attendance, including punctuality and preparedness
• Perform other related duties as assigned

Requirements

• At least 2 years of experience performing quality assurance audits in a call center environment (multi-channel contact center experience preferred)
• 3+ years in a regulated industry with auditing or peer review experience; experience with reading, interpretation, and enforcement of SOPs and policies
• Experience evaluating documents and voice recordings
• Relevant healthcare/insurance/telehealth experience with biologics preferred
• Training skills preferred, but not required
• Bi- or multi-lingual skills (written and verbal), especially Spanish, desired

Minimum Skills, Knowledge, and Ability Requirements

• Exceptional listening and analytical skills
• Excellent attention to detail
• Ability to manage competing deadlines and multiple projects in a fast-paced environment
• Ability to work positively and productively as part of a team or independently
• Strong confidentiality practices
• Proficiency in word processing, spreadsheets, and data analysis (Word, Excel, PowerPoint)
• Knowledge of reimbursement and/or patient assistance programs
• Knowledge of HIPAA and pharmacovigilance regulations/standards preferred
• Knowledge of customer care processes and techniques
• Organization, professionalism, accurate documentation skills, and ability to comply with regulatory requirements
• Excellent communication and interpersonal skills
• Flexibility, attention to detail, and adaptability to change
• Compliance with all laws, regulations, and policies governing CareMetx activities

Physical Demands

The employee is regularly required to sit and occasionally lift and/or move up to 10 pounds.

Work Environment

The noise level in the work environment is usually moderate.

Schedule

• Flexible schedule and hours required
• Minimal travel may be requested (less than 10%)

Pay

$50,000–$63,000 per year