
11 - 50 employees
⚕️ Healthcare Insurance
Healthcare Insurance
Harbor Health is a healthcare provider offering a range of medical services, including Express Care for immediate medical needs like sore throats, seasonal allergies, and annual wellness visits. They emphasize a co-creation approach to health, working collaboratively with patients to achieve optimal health outcomes. Harbor Health provides virtual and traditional appointment options and accepts most insurance plans, ensuring accessible healthcare for their clients. With multiple clinics, including specialized Express Care locations, they focus on offering warm, welcoming, and efficient care, as evidenced by positive patient reviews.
🕒 May 16
🇺🇸 United States – Remote
⏰ Full Time
🟢 Junior
🟡 Mid-level
📞 Call Center Representative
🚫👨🎓 No degree required
🗣️🇪🇸 Spanish Required
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11 - 50 employees
⚕️ Healthcare Insurance
Healthcare Insurance
Harbor Health is a healthcare provider offering a range of medical services, including Express Care for immediate medical needs like sore throats, seasonal allergies, and annual wellness visits. They emphasize a co-creation approach to health, working collaboratively with patients to achieve optimal health outcomes. Harbor Health provides virtual and traditional appointment options and accepts most insurance plans, ensuring accessible healthcare for their clients. With multiple clinics, including specialized Express Care locations, they focus on offering warm, welcoming, and efficient care, as evidenced by positive patient reviews.
• Conduct routine and targeted audits of contact center interactions to evaluate adherence to quality standards, workflows, and regulatory mandates • Ensure all audited interactions and documentation strictly comply with HIPAA, CMS guidelines, internal policies, and quality documentation standards • Apply standardized, objective evaluation criteria and quality scoring methodologies consistently across all interaction types and market segments • Analyze audit results and interaction data to identify emerging performance trends, recurring compliance risks, and systemic process bottlenecks • Document all audit findings, quality scores, and supporting evidence in the tracking system; maintain audit-ready records for internal and external review • Participate actively in calibration sessions to ensure inter-rater reliability and scoring alignment across all QA teams • Provide timely, constructive, and actionable feedback to support coaching, training, and performance improvement for agents and supervisors • Escalate critical quality or compliance issues, potential breaches, or systemic errors to appropriate leadership following established protocols
• 2+ years in a contact center QA role, preferably in a healthcare or managed care environment • Comprehensive knowledge of contact center policies, procedures, and quality scoring frameworks • Solid understanding of HIPAA, CMS, and TDI compliance regulations and ability to apply them in auditing contexts • Strong analytical skills; proficiency with Excel or Tableau for data synthesis and root cause identification • Exceptional written and verbal communication, including clear documentation and professional escalation skills • Meticulous attention to detail; experience maintaining audit trails and quality records • Objectivity and fairness in evaluation; ability to articulate and defend scoring rationale • High learning agility; proven ability to work independently in a fast-paced, ambiguous environment • Preferred Experience auditing in a payvider, ACO, or value-based care contact center • Familiarity with HEDIS, Star Ratings, or URAC/NCQA accreditation standards • Knowledge of grievance, appeals, and prior authorization workflows • Experience with Athena or similar EHR/CRM platforms • Bilingual: English / Spanish
• Opportunity to build Harbor Health's contact center quality program from an early stage — your standards will define how we serve our members • Collaborative, cross-functional environment connecting QA, compliance, clinical, and operations teams • An organization of people passionate about transforming healthcare for underserved Texas communities • Competitive salary and benefits package • Professional development and growth opportunities as Harbor scales its operations • A transparent startup culture that values your expertise and perspective
Apply Now🕒 May 13
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