Quality Program Specialist - Workers Compensation

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.

• Quality Assurance and Issue Management
  • 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.
• Escalation Resolution and Collaboration
  • 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.
• Root Cause Analysis and Continuous Improvement
  • 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.
• Reporting and Documentation
  • Develop and maintain KPI, audit, and process-performance reports.
  • Present findings and recommendations to management.
  • Maintain audit records, procedures, training materials, and process documentation.

• Required
  • 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.
• Preferred:
  • 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.