Quality Program Specialist - Worker's Compensation
About The Position
Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has an exceptional track record of generating the very best outcomes for patients, payers, and providers. Deep clinical expertise is the foundation for every part of Paradigm’s business: risk-based clinical solutions, case management, specialty networks, home health, shared decision support, and payment integrity programs. We’re proud to be recognized—again! For the fourth year in a row, we’ve been certified by Great Place to Work®, and for the third consecutive year, we’ve earned a spot on Fortune's Best Workplaces in Health Care™ list. These honors reflect our unwavering commitment to fostering a positive, inclusive, and employee-centric culture where people thrive. Watch this short video for a brief introduction to Paradigm. Are you passionate about improving quality and driving meaningful change? Paradigm is seeking a full-time Quality Program Specialist to leverage data, uncover insights, and support initiatives that enhance operational performance and service excellence. The ideal candidate brings experience in healthcare or workers’ compensation, strong problem-solving abilities, and a commitment to delivering high-quality outcomes for our clients and customers. The Quality Program Specialist ensures compliance with customer and company quality standards through audits, reporting, issue resolution, and process improvement. This role analyzes quality trends, manages escalations, supports corrective actions, and partners with cross-functional teams to drive continuous improvement and KPI performance.
Requirements
- Bachelor’s degree or equivalent work experience.
- 2–4 years of experience in process improvement, operations analysis, or quality improvement.
- Strong analytical and problem-solving skills.
- Proficiency in MS Office, especially Excel (pivot tables, charts, formulas).
- Excellent written and verbal communication skills.
- Ability to work independently and manage multiple priorities.
Nice To Haves
- Experience in healthcare, workers’ compensation, or bill review operations.
- Familiarity with quality management tools (e.g., root cause analysis, PDCA, Pareto charts).
- Certification in Six Sigma, Lean, or ASQ.
Responsibilities
- Conduct quality audits to ensure accurate documentation and process execution.
- Triage issues and route them to appropriate teams based on complexity and urgency.
- Monitor process quality and compliance with established standards.
- Manage escalated issues through resolution, ensuring timely communication with stakeholders.
- Partner with internal teams (Referral Management, Network Development, Network Billing, Account Management, Network Services, IT) to resolve complex issues.
- Serve as a liaison between internal and external stakeholders as needed.
- Perform monthly root cause analysis of recurring issues and escalations.
- Identify trends and recommend corrective and preventive actions.
- Support continuous improvement initiatives and process enhancements.
- Develop and maintain KPI, audit, and process-performance reports.
- Present findings and recommendations to management.
- Maintain audit records, procedures, training materials, and process documentation.
Benefits
- PPO, HDHP, and HMO health insurance options with Cigna and Kaiser (CA employees only).
- Competitive salaries
- 401(k) matching contributions
- Employer-paid life and disability insurance
- Flexible spending and commuter accounts
- Employer-matched HSA contributions
- Paid time off
- Personal holiday programs
- One paid day of volunteer time per calendar year.
- Learning Excellence at Paradigm (LEAP) program.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
