Quality Assurance Officer

Job Summary

The Quality Assurance Officer is responsible for monitoring, evaluating, and improving the quality of service delivery and operational processes within the Health Maintenance Organization (HMO). The role ensures that employees comply with company policies, service standards, regulatory requirements, and established procedures while maintaining a high level of customer satisfaction and operational efficiency.

Key Responsibilities

1.

• Monitor and evaluate customer service interactions, including phone calls, emails, and other communication channels.
• Conduct regular quality audits of Member Care, and other operational departments.
• Assess employee performance based on established quality standards and service level agreements (SLAs).
• Identify service gaps, recurring errors, and areas for improvement.

1. Compliance and Process Improvement

• Ensure compliance with company policies, standard operating procedures (SOPs), and applicable healthcare regulations.
• Review operational processes to ensure accuracy, consistency, and efficiency.
• Identify potential operational risks and recommend corrective and preventive actions.
• Ensure proper handling and confidentiality of member information and medical records.

1. Reporting and Documentation

• Prepare and submit regular quality assessment reports and performance scorecards.
• Track quality performance indicators, customer complaints, and audit findings.
• Maintain accurate documentation of quality reviews, observations, and recommendations.
• Present quality performance results and improvement initiatives to management.

1. Training and Development

• Provide feedback and coaching recommendations to employees based on quality evaluation results.
• Coordinate with department heads and trainers to address recurring service issues.
• Assist in developing quality standards, evaluation forms, and training materials.
• Conduct quality calibration sessions to ensure consistent evaluation standards.

1. Customer Experience and Service Excellence

• Evaluate the quality of member and provider interactions.
• Identify opportunities to improve member satisfaction and overall service experience.
• Monitor the resolution of customer complaints and service-related concerns.
• Recommend initiatives to enhance service delivery and operational performance.

Qualifications

• Bachelor's degree in Business Administration, Healthcare Management, Nursing, or a related field.
• At least 1–3 years of experience in Quality Assurance, Quality Control, or Operations, preferably in the HMO, healthcare, insurance, or BPO industry.
• Knowledge of HMO operations, healthcare services, claims processing, and member care is an advantage.
• Familiarity with quality management systems, audit procedures, and performance monitoring.
• Strong analytical, problem-solving, and communication skills.
• Proficient in Microsoft Office applications, particularly Excel and reporting tools.
• Excellent attention to detail and organizational skills.

Benefits:

• Company Christmas gift
• Company events
• Opportunities for promotion
• Promotion to permanent employee

Work Location: In person