QA Associate

ConnectiveRx•Pittsburgh, PA

8d•$19 - $26•Onsite

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 adherence to established expectations. This role requires strong critical thinking and objective decision-making skills to determine whether audited work meets both internal and external quality standards. The Operations Quality Assurance Associate I serves as a subject matter expert for assigned business units and uses analytical skills to review data, processes, and workflows. This role provides meaningful, actionable coaching to Operations Agents to support quality improvement and operational excellence.

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.
Experience in healthcare operations, customer service, or quality assurance environments preferred.
Working knowledge of quality-focused services, including accuracy management, performance metrics, customer experience, healthcare benefits, and SOP execution.
Healthcare industry experience in claims processing, contact centers, benefit verification, or related areas is required.
Call center and/or claims processing experience is a plus.
Proficiency with Microsoft Office Suite, including Word, Excel, Outlook, SharePoint, and Teams.
Bilingual English/Spanish skills are a plus.
Strong analytical, organizational, and communication skills.
Ability to provide constructive feedback and coaching.
Communication (Oral & Written): Communicates clearly and professionally with a variety of audiences. Actively listens and shares relevant information effectively. Adapts communication style based on audience and situation.
Service Orientation: Demonstrates a customer-focused approach. Anticipates and responds to the needs of internal and external customers. Shows empathy, professionalism, and a commitment to service excellence.
Decision Quality: Makes informed, timely decisions using analysis, experience, and sound judgment. Ensures compliance with company policies, procedures, and values. Remains effective when working with incomplete information.
Process Knowledge: Understands, documents, and monitors key business processes. Identifies opportunities for process improvement. Supports the development and implementation of process enhancements and procedural documentation.
Adhere to all company policies, procedures, and training requirements related to ConnectiveRx’s Information Security and Compliance Programs.
Maintain compliance with applicable standards and regulations, including SOC1, SOC2, PCI, and HIPAA.
Follow all company and client business rules, ethical standards, and applicable local, state, and federal laws and regulations.

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.