Quality Program Specialist

Paradigm • Walnut Creek, CA

1d • Remote

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.
We are seeking a full-time, remote Quality Program Specialist. The Quality Program Specialist is responsible for ensuring quality standards are compliant with customer requirements and consistent with company standards through quality audit processes and regular reporting. This role supports quality assurance through triage, escalation management, cause analysis, and collaboration with cross-functional teams. The specialist will lead monthly reporting of KPIs, document findings, and contribute to continuous process improvement initiatives. The ideal candidate will have strong analytical skills, a background in healthcare or workers’ compensation, and experience in quality management and operational problem-solving.

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

• Perform quality audits on processes.
• Triage issues to appropriate teams based on complexity and urgency.
• Ensure consistent and accurate documentation & Process execution.
• Manage and track escalated issues, ensuring timely resolution and stakeholder communication.
• Collaborate with internal departments (e.g. Referral Management, Network development, Network Billing, Account Management, Network Services, IT) to resolve complex problems.
• Act as a liaison between internal teams and external when needed.
• Conduct monthly root cause analysis of recurring issues and escalations.
• Identify patterns and trends to inform Management
• Recommend and support implementation of corrective actions and preventive measures.
• Develop and maintain reports for KPIs, audit results, and process metrics.
• Present findings to management and contribute to continuous improvement.
• Maintain documentation of audit, procedures, training materials, and process workflows.
• Maintain reliable and predictable attendance during scheduled work hours.

Benefits

• Health and wellness– We want our people to be and stay healthy, so we offer PPO, HDHP, and HMO health insurance options with Cigna and Kaiser (CA employees only).
• Financial incentives – Paradigm’s financial benefits help prepare you for the future: competitive salaries, 401(k) matching contributions, employer-paid life and disability insurance, flexible spending and commuter accounts, and employer-matched HSA contributions.
• Vacation - We believe strongly that work-life balance is good for you and for our company. Our paid time off and personal holiday programs give you the flexibility you need to live your life to the fullest.
• Volunteer time– We want our employees to engage with and give back to their communities in meaningful ways. Full and part-time employees receive one paid day per calendar year.
• Learning and development: One of Paradigm’s core values is expertise, so we encourage our employees to continually learn and grow. We support this in a variety of ways, including our new Learning Excellence at Paradigm (LEAP) program.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level