Everise logo
Everise

Champions of customer happiness. Providing award-winning healthcare customer services and CRM solutions.

Quality Analyst Participant Services

Location

United States

Posted

2 days ago

Salary

0

Seniority

Mid Level

No structured requirement data.

Job Description

Quality Analyst Participant Services

Everise

Role Description - Perform routine quality audits using approved scorecards. - Evaluate documentation accuracy and policy adherence. - Prepare weekly and monthly quality reports. - Provide objective audit feedback to leaders. - Identify root causes and recurring defect trends. - Support coaching effectiveness through post-audit validation. - Monitor daily operational performance against SLA, productivity, quality, and schedule adherence goals. - Ensure compliance with HIPAA, CMS, state board of pharmacy requirements, and internal policies. - Use reporting to identify trends and recommend corrective actions. - Partner with Workforce Management, Training, Operations, and Leadership. - Support continuous improvement initiatives and standardization efforts. - Maintain documentation and confidentiality standards. - Participate in calibration sessions and business meetings. - Lead or support special projects as assigned. - Support non-clinical prescription processing and participant service workflows. Qualifications - Strong written and verbal communication. - Leadership and relationship-building skills. - Critical thinking and analytical ability. - Ability to prioritize competing demands. - Experience working across multiple pharmacy systems. - Proficiency with Microsoft Office, particularly Excel. - Ability to maintain confidentiality. Requirements - High School Diploma or GED. - Three or more years of relevant PBM, specialty pharmacy, participant services, or healthcare operations experience. - Previous leadership or quality experience appropriate to the role. Preferred Qualifications - Active Arizona or Texas Pharmacy Technician License. - National Pharmacy Technician Certification (CPhT). - PBM or specialty pharmacy experience. - Call center healthcare operations experience. - Lean/Six Sigma or process improvement exposure. - Experience presenting operational metrics. Performance Measures - Quality audit performance - Productivity and throughput - Service Level (SLA) attainment - Attendance and schedule adherence - Compliance and documentation accuracy - Customer experience - Coaching effectiveness and continuous improvement Work Environment & Physical Requirements Fast-paced, computer-based participant services environment requiring prolonged sitting, frequent computer use, telephone communication, and the ability to manage multiple priorities while maintaining accuracy and professionalism.

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