QA Analyst - Patient Support

Monitor and evaluate recorded and/or live patient support interactions, case documentation, and related workflow activity using approved scorecards and client/program standards.

Assess the accuracy and completeness of information provided regarding copays, deductibles, coinsurance, out-of-pocket responsibilities, eligibility, benefit verification, copay programs, and other assigned patient-support topics.

Evaluate pharmacy claim-support activity for adherence to established procedures, including common rejections, refill-too-soon issues, coordination of benefits, prior authorization status support, plan limitations, and appropriate escalation.

Evaluate patient identity verification, HIPAA/privacy practices, required scripting or disclosures, documentation quality, professionalism, empathy, and adherence to call and case-handling procedures.

Promptly escalate critical errors, compliance or privacy concerns, patient-safety concerns, and material process deviations through established channels.

Participate in regular calibration sessions with Quality, Operations, Training, and other stakeholders to promote consistent scoring and interpretation of standards.

Provide clear, objective, documented feedback identifying strengths, errors, and improvement opportunities for leader coaching and development.

Analyze recurring quality trends, error patterns, customer-experience themes, and process breakdowns and communicate actionable findings to Quality, Operations, and Training leadership.

Recommend refresher training, job aids, workflow clarification, scripting updates, or process improvements when recurring quality gaps are identified.

Support new-hire nesting, targeted monitoring, remediation efforts, and other quality initiatives while maintaining objective evaluation standards.

Reporting, Documentation & Compliance

Complete assigned quality reviews within established productivity, timeliness, and accuracy expectations and maintain complete audit records.

Track and report quality results, critical-error trends, documentation accuracy, compliance findings, and other assigned quality measures using approved tools.

Maintain confidentiality of patient information, employee performance information, recorded interactions, and audit findings and follow all applicable HIPAA, privacy, information security, and client requirements.

Support internal, client, and program quality reviews by organizing audit evidence, validating findings, and providing supporting documentation.

Follow Omega and client quality policies, scorecards, escalation paths, and security requirements and raise unclear or conflicting standards for review.

Key Success Indicators/Attributes

Complete assigned quality reviews accurately and within established service levels, productivity expectations, and audit schedules.

Maintain strong calibration alignment and apply quality standards objectively and consistently across representatives and interaction types.

Identify critical errors and compliance risks promptly and escalate them with complete supporting documentation.

Produce clear, actionable, fact-based feedback that supports coaching, training, process improvement, and a high-quality patient experience.

Demonstrate strong analytical ability, attention to detail, written communication, and sound judgment when reviewing healthcare, insurance, and pharmacy-support interactions.

Adapt effectively to changes in client requirements, quality standards, workflows, systems, products, and operating procedures.

Maintains confidentiality, professionalism, reliability, and constructive working relationships with Operations, Training, Quality, and other internal partners.

Supervisory Responsibility

None required. This role provides quality feedback and audit findings but does not independently administer discipline or performance-management actions.

This role operates in a professional contact center environment, which may be onsite, hybrid, or remote depending on the assigned program and client requirements. The position routinely uses a computer, telephone/headset, dual monitors, quality-monitoring tools, CRM/case management systems, reporting applications, and multiple client systems and requires sustained attention to recorded interactions, documentation, and data analysis.

Physical Demands

The physical demands are representative of those required to perform the essential functions of this role.

The position primarily involves sitting, listening, speaking, typing, and viewing computer screens for…