QA Analyst - Patient Support

Omega • Boca Raton, FL

7h

About The Position

The QA Analyst monitors and evaluates patient-support interactions, case documentation, and related workflows against approved scorecards and client or program standards. The role assesses the accuracy and completeness of healthcare and pharmacy-support information, including insurance responsibilities, eligibility, benefit verification, pharmacy claims, and appropriate escalation. It also evaluates identity verification, privacy practices, required disclosures, documentation, professionalism, empathy, and compliance with handling procedures. Critical errors, privacy or compliance concerns, patient-safety issues, and material process deviations must be promptly escalated.

The position participates in calibration with Quality, Operations, Training, and other stakeholders; provides objective, documented feedback; analyzes quality trends and recurring process issues; and recommends training or workflow improvements. It may support new-hire nesting, targeted monitoring, remediation, and other quality initiatives. The analyst completes reviews within established service levels and maintains audit records, reports results using approved tools, protects confidential information, and supports internal, client, and program quality reviews.

This is a full-time, non-exempt position with no supervisory responsibility. Work hours, time-zone coverage, weekend or holiday requirements, and onsite, hybrid, or remote arrangements depend on the assigned program and client requirements. Flexibility may be needed for calibration, training, and other quality needs. The role is performed in a professional contact center environment and involves extended periods of sitting, listening, speaking, typing, and viewing screens, with occasional standing and walking. Regular travel is not expected.

Requirements

• High school diploma or GED.
• Two or more years of experience in a healthcare, pharmacy billing, patient-support, insurance, or similar contact center environment, with demonstrated knowledge of call handling, documentation, quality expectations, or regulated workflows.
• Working knowledge of U.S. healthcare insurance and pharmacy-support concepts, including copays, deductibles, coinsurance, out-of-pocket maximums, benefit verification, pharmacy claim responses, coordination of benefits, and common rejection scenarios.
• Strong analytical, written, and verbal communication skills, including the ability to evaluate interactions objectively, document findings clearly, interpret procedures, and distinguish coaching opportunities from critical or compliance errors.
• Proficiency with contact center technology, CRM or case-management systems, quality-monitoring tools, Microsoft Office applications, and multiple data sources.
• Ability and willingness to complete required Omega, client, and program training, including quality calibration, emotional sensitivity, privacy, security, systems, and program-specific training.
• Ability to communicate constructively with representatives, supervisors, managers, trainers, Quality team members, and healthcare-related stakeholders while maintaining objectivity and confidentiality.
• Ability to meet applicable privacy, HIPAA, information-security, and acceptable-use requirements for access to protected health information, recorded interactions, employee quality records, and assigned systems.

Nice To Haves

• One or more years of quality assurance, quality monitoring, auditing, coaching, training, or advanced-agent experience in a healthcare, pharmacy, patient-support, or regulated contact center environment.
• Certified Pharmacy Technician (CPhT) certification through PTCB or another nationally recognized certifying organization.
• Active state pharmacy technician registration or licensure where applicable.
• Spanish-English bilingual proficiency, particularly for monitoring Spanish-language patient interactions and assessing accuracy, professionalism, and clarity in both languages.
• Additional post-secondary education, healthcare-related training, quality assurance training, or contact center quality certification.

Responsibilities

• Monitor and evaluate recorded or live patient-support interactions, case documentation, and related workflow activity using approved scorecards and client or program standards.
• Assess the accuracy and completeness of information about insurance costs and responsibilities, eligibility, benefit verification, copay programs, and assigned patient-support topics.
• Evaluate pharmacy claim-support activity for adherence to procedures, including common rejections, refill-too-soon issues, coordination of benefits, prior authorization status, plan limitations, and escalation.
• Evaluate identity verification, HIPAA and privacy practices, required scripting or disclosures, documentation quality, professionalism, empathy, and call and case-handling procedures.
• Promptly escalate critical errors, compliance or privacy concerns, patient-safety concerns, and material process deviations through established channels.
• Participate in calibration sessions with Quality, Operations, Training, and other stakeholders.
• Provide clear, objective, documented feedback identifying strengths, errors, and improvement opportunities for coaching and development.
• Analyze recurring quality trends, error patterns, customer-experience themes, and process breakdowns, and communicate actionable findings to leadership.
• Recommend refresher training, job aids, workflow clarification, scripting updates, or process improvements when recurring quality gaps are identified.
• Support new-hire nesting, targeted monitoring, remediation efforts, and other quality initiatives while maintaining objective evaluation standards.
• Complete assigned quality reviews within productivity, timeliness, and accuracy expectations and maintain complete audit records.
• Track and report quality results, critical-error trends, documentation accuracy, compliance findings, and other assigned quality measures using approved tools.
• Maintain confidentiality of patient information, employee performance information, recorded interactions, and audit findings; follow applicable HIPAA, privacy, information-security, and client requirements.
• Support internal, client, and program quality reviews by organizing audit evidence, validating findings, and providing supporting documentation.
• Follow Omega and client quality policies, scorecards, escalation paths, and security requirements; raise unclear or conflicting standards for review.
• Complete required Omega, client, and program training and communicate constructively with representatives, supervisors, managers, trainers, Quality team members, and healthcare-related stakeholders while maintaining objectivity and confidentiality.

Benefits

• Health coverage
• Dental coverage
• Vision coverage
• Voluntary insurance options
• 401(k) plan with employer match
• Professional development opportunities
• Paid time off
• Holiday pay
• Potential eligibility for bonus programs, commissions, or other variable incentive plans

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED