Quality Analyst

4 days ago

Cebu City P, Philippines Virtual Staffing Solutions Full time ₱900,000 - ₱1,200,000 per year
Description

The Quality Analyst (QA) is responsible for monitoring, evaluating, and improving the quality of service provided in medical referral processing, prior authorizations, and eligibility verification processes within a healthcare BPO environment. The QA ensures compliance with client-specific protocols, healthcare regulations (such as HIPAA), and internal quality standards.

Key Responsibilities

Monitor and evaluate daily interactions and transactions related to medical referrals, prior authorizations, and eligibility verification.

Perform audits of voice calls, chats, emails, and back-office transactions to ensure accuracy, compliance, and adherence to process flows.

Analyze performance data to identify trends, gaps, and areas for process improvement.

Provide actionable feedback and coaching to agents in collaboration with team leads or supervisors.

Collaborate with the Training and Operations teams to address quality gaps and ensure continuous improvement.

Assist in developing quality scorecards, audit forms, and QA guidelines specific to healthcare accounts.

Maintain accurate documentation of audit results and quality reports for internal and client review.

Participate in calibration sessions with internal teams and clients to ensure consistent quality expectations.

- Stay updated on healthcare industry trends, payer rules, and changes in medical referral/authorization/eligibility procedures.

Skills, Knowledge & Expertise
  • Consistently high performer in current SCI campaigns - Authorizations, Referrals, and Eligibility
    Strong knowledge of U.S. healthcare processes, including medical referrals, prior authorizations, and eligibility verification.

    Familiarity with HIPAA regulations and healthcare terminology.

    Excellent analytical, communication, and documentation skills.

    Proficient in MS Office tools and QA monitoring platforms.

    High attention to detail and accuracy.
  • Ability to work independently and as part of a team.
About Virtual Staffing Solutions

We specialize in delivering innovative solutions and exceptional services to meet the diverse needs of our clients. With a strong commitment to quality and customer satisfaction, we strive to exceed expectations and drive success in every project we undertake.

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