From intake to outcomes, CareMetx is dedicated to delivering industry-leading patient access solutions and support services that help patients quickly start and stay on specialty therapy treatments. We provide scalable, efficient digital hub services for pharmaceutical companies and healthcare providers, streamlining workflows with seamless integration for patient enrollment, consent, and prior authorization. Our best-in-class patient support services enhance every step of care, connecting patients, providers, and brands to drive better outcomes and accelerate time-to-therapy.

JOB TITLE: Quality Specialist

POSITION SUMMARY:

The Quality Specialist will be responsible for monitoring and documenting program performance in support of departmental goals and initiatives. The Quality Specialist will evaluate both verbal and written interactions by program support staff and will work directly with Program Operations and Quality Management to design and update quality monitoring formats and quality standards. The Quality Specialist will fairly and consistently review the team interactions with both internal and external parties for accuracy and support success in executing superior service and quality. The Quality Specialist will identify areas of opportunity for coaching, feedback, and education to support program objectives. The Quality Specialist will assist with the development and delivery of regular reports on performance, trends, and other actionable insights to the Operations Leadership Team. 

PRIMARY DUTIES AND RESPONSIBILITIES:

• Monitors interactions, support request processing, and electronic records for accuracy of information, process/policy adherence, and call handling standards
• Ensures that interactions and support requests are executed with a superior level of customer service
• Monitor, identify and report adverse events, nonadherence to patient identification practices, off-label use, and provision of medical advice during interactions with patients (and other contact interactions). 
• Participate in downloading and de-identifying program interactions for review  
• Monitors performance quality of the program team and vendor partners
• Documents evaluations utilizing departmental quality monitoring templates established quality standards, and quality monitoring technology
• Maintains and improves service quality by completing system, compliance, and process audits.
• Work with leadership to review and resolve any disputes brought forward regarding compliance scoring or standards.  
• Daily review of writen communications such as call notes, inbound SMS, and voicemails for pharmacovigilance information to validate they have been processed according to compliance standards in accordance with program requirements.
• Willingness to provide support and coverage for fellow team members in the event of unplanned and planned time off (PTO) 
• Participates in regular calibration meetings with QA, Training, and Operations Leadership to ensure consistency of expectations, standards, and evaluations
• Provide reports to management, periodically
• Proactively identifies trends based on quality evaluations and provide program Operations leadership with regular performance feedback
• Contribute and support design and/or enhancement to quality monitoring forms and quality standards
• Updates job knowledge by studying trends in and developments in quality management; participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations.
• Continuously researches new technologies and methodologies in contact center QA monitoring and presents this research.
• Maintain regular and reliable attendance, including being present, on time, and prepared for work as scheduled.
• Performs other related duties as assigned.

EXPERIENCE AND EDUCATIONAL REQUIREMENTS:

• Preference to have at least 2 years of experience performing quality assurance audits in a call center environment (Multi-channel Contact Center Experience Preferred)
• 3+ years in a regulated industry with auditing or peer review experience preferred, experience with reading, interpretation, and enforcement of SOPs and policies
• Experience evaluating document and voice recordings
• Relevant healthcare/insurance/telehealth experience with biologics
• Training Skills preferred, but not necessary
• Bi-or Multi-lingual skills (written and verbal) desired (Spanish)

MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:

• Exceptional listening and analytical skills required
• Excellent attention to detail
• Ability to manage competing deadlines and multiple projects in a fast-paced environment.
• Work positively and productively as part of a team.
• Work independently.
• Maintain confidentiality.
• Computer skills including word processing, spreadsheets, and general data analysis (Proficient in Word, Excel, and PowerPoint for presentation and report development)
• Knowledge of reimbursement and/or patient assistance programs
• Knowledge of HIPAA and pharmacovigilance regulations/standards preferred.
• Knowledge of customer care processes and techniques
• Organization, professionalism, accurate documentation skills and the ability to comply with regulatory requirements are essential.
• Excellent communication and interpersonal skills
• Flexible, detailed, and able to successfully adapt to change
• Complies with all laws, regulations, and policies that govern the conduct of CareMetx activities related to the programs

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to sit
• The employee must occasionally lift and/or move up to 10 pounds.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

SCHEDULE:

• Must be flexible on schedule and hours
• Minimal travel may be requested (<10% travel)

CareMetx considers equivalent combinations of experience and education for most jobs. All candidates who believe they possess equivalent experience and education are encouraged to apply.

At CareMetx we work hard, we believe in what we do, and we want to be a company that does right by our employees. Our niche industry is an integral player in getting specialty products and devices to the patients who need them by managing reimbursements for those products, identifying alternative funding when insurers do not pay, and providing clinical services.

CareMetx is an equal employment opportunity employer. All qualified applicants will receive consideration for employment and will not be discriminated against based on race, color, sex, sexual orientation, gender identity, religion, disability, age, genetic information, veteran status, ancestry, or national or ethnic origin.

Artificial Intelligence in Our Recruiting and Employment Process

CareMetx uses artificial intelligence and automated decision-making technology to support parts of our recruiting, hiring, and employment process, including screening applications, scheduling interviews, and evaluating candidate qualifications. These tools support, not replace, human judgment. A qualified member of our team reviews and makes all final hiring and employment decisions.

CareMetx does not develop or use AI tools with the intent to discriminate against applicants or employees on the basis of race, color, religion, sex, age, sexual orientation, national origin, disability, veteran status, or any other protected characteristic.