QA Associate

ConnectiveRx•Pittsburgh, PA

13h

About The Position

The Operations Quality Assurance Associate I evaluates work completed by Operations Agents against program SOPs, WINs, business rules, and other program-related documents to ensure it meets established internal and external quality standards. The role uses critical thinking, objective decision-making, and analytical skills to review data, processes, and workflows, and serves as a subject matter expert for assigned business units. The associate provides actionable coaching to Operations Agents to support quality improvement and operational excellence. The position evaluates work across operational products and services, including benefit verification and patient assistance cases, software support calls and emails, inbound calls from patients and healthcare providers, and data entry. It partners with Training, participates in quality calibrations, and escalates critical concerns. Occasional evening and/or weekend hours may be required based on business needs. The role requires adherence to company and client policies, procedures, business rules, ethical standards, and applicable laws and regulations. It also requires compliance with information security and compliance programs and standards, including SOC1, SOC2, PCI, and HIPAA. The work is primarily sedentary and involves operating standard office equipment and computer systems. The posted salary range is USD $18.98–$28.80 per hour. The position offers opportunities for a bonus or commissions. Benefits include medical, dental, vision, life, and disability insurance; access to a 401(k) plan with employer contributions where applicable; flexible PTO for exempt employees; eight standard company holidays; and three floating holidays annually.

Requirements

High school diploma or equivalent required; relevant experience may be considered in place of formal education requirements.
0–2 years of experience as a Case Manager, Benefit Verification Specialist, Contact Center Agent, or in a similar role.
Healthcare industry experience in claims processing, contact centers, benefit verification, or related areas is required.
Working knowledge of quality-focused services, including accuracy management, performance metrics, customer experience, healthcare benefits, and SOP execution.
Proficiency with Microsoft Office Suite, including Word, Excel, Outlook, SharePoint, and Teams.
Strong analytical, organizational, and communication skills.
Ability to provide constructive feedback and coaching.
Ability to sit, stand, see, hear, speak, and perform repetitive computer and office-related tasks.
Ability to operate standard office equipment and computer systems.

Nice To Haves

Experience in healthcare operations, customer service, or quality assurance environments preferred.
Call center and/or claims processing experience is a plus.
Bilingual English/Spanish skills are a plus.

Responsibilities

Coach Operations Agents through peer-to-peer feedback on opportunities identified during quality evaluations.
Partner with Training to support new hire, refresher, and nesting training programs.
Perform and document quality assurance evaluations across operational products and services, including benefit verification cases, patient assistance cases, software support calls and emails, inbound calls from patients and healthcare providers, data entry activities, and other operational functions.
Participate in internal, vendor, and client calibration meetings related to quality initiatives.
Identify and appropriately escalate critical quality concerns to senior management.
Support additional quality assurance functions and responsibilities as needed to help achieve department and company goals.
Be available to work occasional evening and/or weekend hours based on business needs.
Audit work completed by Operations Agents.
Perform other duties as assigned.
Adhere to company policies, procedures, and training requirements related to information security and compliance programs.
Maintain compliance with applicable standards and regulations, including SOC1, SOC2, PCI, and HIPAA.
Follow company and client business rules, ethical standards, and applicable local, state, and federal laws and regulations.