Quality Assurance Coordinator - Healthcare

Quality Assurance Coordinator - Healthcare

MarketSource is a sales acceleration company focused on delivering better outcomes for many of the world’s most iconic brands. We design, operationalize, and execute managed sales and customer experience solutions for companies in B2B and B2C environments.

Our solutions are purpose-built and tech-enabled to deliver measurable improvements in business outcomes. We live by a set of people-focused values that guide our relationships with each other and with our clients. By putting people first, working together to make others successful, and establishing a rich and empowered work culture, we create opportunities for our people and the businesses we serve to be successful.

Summary

As a Quality Assurance Coordinator servicing health insurance industry clients, you will ensure best-in-class quality assurance in a highly regulated environment. Working closely with the Quality Assurance Supervisor, this role is responsible for ensuring that agent-member interactions, program documentation and processes, meet client requirements and compliance standards with respect to applicable regulations (e.g. HIPAA, CMS). By evaluating performance against program requirements and compliance standards, this position plays a critical role in identifying initiatives related to automation, coaching, auditing, data reporting and training.

More specifically, you will monitor agent/customer interactions, conduct audits, and participate in continuous improvement initiatives to meet or exceed client contractual quality commitments and enhance customer satisfaction. In this role, you will collaborate with team members across the organization to uphold high performance standards and implement innovative quality solutions.

Essential Job Functions:

• Call Monitoring & Evaluation: Monitor and evaluate inbound and outbound calls to assess compliance, service quality, accuracy, and adherence to scripts and policies. Use standard scorecards to rate communication skills, compliance, and resolution effectiveness for each interaction.

• Compliance Audits: Conduct regular QA audits of customer service interactions, documents, and processes to ensure adherence to health insurance regulations and client requirements (e.g. verify HIPAA privacy compliance, Medicare/CMS guidelines).

• Feedback & Coaching: Identify constructive feedback and coaching opportunities for call center agents focused on improving customer service skills and compliance. Partner with relevant internal stakeholders to develop refresher training or new learning modules for recurring issues.

• Quality Reporting & Analysis: Analyze QA data and metrics (quality scores, error trends, customer feedback) to identify trends, root causes, and areas for improvement. Prepare and present detailed quality reports for Supervisors, highlighting performance against KPIs and recommending actions. Ensure all reporting is timely, accurate, and aligned with client SLAs.

• Customer Service & Continuous Improvement: Champion a customer-centric approach in quality programs, ensuring that QA standards align with exceptional customer service and positive member experiences. Promote a culture of continuous improvement and innovation, introducing initiatives (e.g. process automation, updated QA scorecards, new monitoring techniques) that elevate quality and efficiency.

• Contractual & SLA Adherence: Maintain QA schedules (e.g. call sampling rates) and partner with applicable stakeholders to ensure quality targets are met or exceeded.

• Regulatory Compliance Assurance: Stay up-to-date on all relevant health insurance industry regulations and client compliance standards. Ensure quality processes and agent evaluations incorporate checks for regulatory requirements (e.g. proper call disclosures, data privacy and security protocols, documentation accuracy). Conduct focused compliance monitoring (such as verifying HIPAA procedures on calls) and support any external audits or quality assessments by providing necessary documentation and reports.

Required Knowledge, Skills, and Abilities:

• Analytical & Reporting Skills: Strong analytical abilities with experience in data analysis and QA metrics interpretation. Proficiency in creating and sharing quality reports, presentations, and dashboards for stakeholders. Able to identify trends and root causes from data and drive actionable insights for process improvements.

• Communication & Coaching: Excellent verbal and written communication skills. Ability to deliver clear, constructive feedback and training to frontline employees to improve performance. Strong interpersonal skills with a collaborative approach to work effectively with agents, trainers, managers, and clients.

• Knowledge of Compliance Standards: In-depth knowledge of health insurance regulations and compliance requirements, including HIPAA privacy/security rules and Medicare/Medicaid guidelines for call centers. Demonstrated commitment to maintaining confidentiality and data security in handling Protected Health Information.

• Organizational Skills: Detail-oriented and highly organized, with the ability to manage QA review schedules, multitask across different client programs, and meet strict deadlines for reports and audits. Capable of maintaining documentation and records with a strong attention to detail for auditing purposes.

• Problem-Solving & Improvement Mindset: A proactive mindset focused on continuous improvement and innovation in quality processes. Ability to troubleshoot quality issues, facilitate root cause analysis, and implement process or policy enhancements that improve service outcomes. Adaptable to change and able to update QA criteria as business needs and industry standards evolve.

• Technical Proficiency: Proficient with standard office software (e.g. MS Excel, Word, PowerPoint) and experienced in using call center QA monitoring tools. Hands-on experience with quality management systems or call recording software is preferred. Comfortable working with Customer Relationship Management (CRM) systems and contact center telephony platforms; able to quickly learn new software and analytics tools related to quality monitoring.

Job Requirements:

• High school diploma or GED required.

• Experience: 2+ years of experience in call center quality assurance, with prior QA experience in the health insurance or healthcare industry strongly preferred. Familiarity with health insurance products, terminology, and member services processes is essential. Experience in a BPO/outsourcing environment or high-volume contact center is highly valued.

• Compliance Training: HIPAA compliance certification or formal training in privacy and security of healthcare information is strongly preferred. Any additional certifications in healthcare compliance or call center compliance (e.g., CMS training) would be beneficial.

• QA/Customer Service Certifications: Certifications in call center quality or customer service (for example, COPC or other contact center excellence certifications) are an advantage, as they demonstrate knowledge of industry best practices in quality assurance and customer experience.

• Quality Monitoring Software: Proficiency with call recording and quality management systems for evaluating interactions and tracking QA data. Experience leveraging these tools to create scorecards, record evaluations, and generate QA reports.

• Contact Center Technologies: Working knowledge of call center telephony systems, CRM software, and workforce management tools. Ability to navigate systems commonly used in health insurance BPO operations to verify information during QA reviews.

• E-Learning/Training Tools: Experience with e-learning platforms or Learning Management Systems (LMS) is a plus, to coordinate agent training and track the effectiveness of coaching interventions related to quality improvement.