Quality Assurance Analyst – Customer Care

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Capital Rx

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2017

⚕️ Healthcare Insurance

💳 Fintech

🤖 Artificial Intelligence

Healthcare Insurance • Fintech • Artificial Intelligence

Capital Rx is the fastest growing healthtech company in America, dedicated to transforming the prescription pricing and patient care landscape. Founded in 2017, it offers innovative pharmacy benefit management (PBM) services, including customizable pharmacy benefits for large employers and an AI-powered care navigation platform. Capital Rx focuses on delivering cost-effective solutions and operational efficiencies to clients while ensuring transparency and quality care for patients.

📋 Description

• Collaborate with leadership to develop and maintain customer care quality scorecards • Conduct quality evaluations of recorded and live customer interactions • Assess agent adherence to procedures and compliance procedures • Facilitate and participate in calibration sessions • Support Customer Satisfaction (CSAT) calibration efforts • Analyze QA data and reporting to identify trends • Provide performance reporting and support to supervisors • Identify training needs through QA evaluations • Oversee the end-to-end processing of member complaints and grievances • Review, document, and research Authorized Representative (AOR) forms • Ensure timely and accurate completion of QA reporting • Handle inbound or outbound calls as needed • Report any compliance concerns or policy violations

🎯 Requirements

• 4+ years’ experience with call center operations, with at least 2 years of experience with Quality Assurance or training • PBM or Healthcare call center operations experience preferred • Bachelor’s degree preferred, or equivalent experience • Knowledge of HIPAA and Privacy Rule regulations • Knowledge of Medicare • A self-starter with outstanding customer service skills • Demonstrate aptitude to develop processes and coach frontline customer service employees • Strong analytical and organizational skills

🏖️ Benefits

• Health insurance • Retirement plans • Paid time off • Flexible work arrangements