The QA Specialist is responsible for ensuring the highest standards of accuracy and compliance in call quality and service documentation. This role plays a critical part in supporting Pyx Health's mission by monitoring contract compliance, enhancing resource efficiency, and driving improvements that lead to better engagement and retention of vulnerable members.

The QA Specialist will work proactively to address operational challenges, optimize service quality, and help fulfill Pyx Health's commitment to improving social health outcomes for underserved populations.

*MUST BE LOCATED IN THE UNITED STATES*

ESSENTIAL DUTIES:

• Call Evaluations:
  • Review and evaluate calls completed by Enrollment and Engagement Agents to assess the quality of service, accuracy of information, adherence to procedures and compliance.
  • Document, report, and communicate findings from call evaluations, including trends, opportunities for improvement, and strengths.

• Contract Compliance:
  • Monitor compliance with contractual obligations, including service level agreements (SLAs) and key performance indicators (KPIs), to prevent costly penalties while ensuring alignment with Medicaid and Medicare regulations.
• Member Engagement:
  • Improve service quality to enhance member satisfaction and retention, contributing to Pyx Health’s mission to reduce loneliness and improve well-being among vulnerable populations.
• Complaint Analysis:
  • Investigate and report on complaints raised by members and clients to identify trends, root causes, and areas for improvement.
• Preventive Measures:
  • Proactively address potential compliance or service quality issues, ensuring timely interventions to prevent escalation and minimize risk to the organization and members.

• Full bilingual professional proficiency in Spanish and English including speaking, reading, and writing.
• Excellent verbal and written communication skills to support continuous training and staff development, reinforcing Pyx Health’s compassionate approach to care.
• Written and verbal proficiency in English and Spanish (required)
• Demonstrated experience in quality assurance, with a focus on communication, compliance, and improving member outcomes.
• Strong understanding of healthcare regulatory requirements, particularly in Medicaid and Medicare environments.
• Ability to identify and communicate operational improvements that enhance resource utilization and service delivery.
• Experience in mitigating risks and preventing compliance issues before they escalate.
• Analytical skills to interpret performance metrics and implement changes that drive member engagement and retention.

SKILLS:

• Ability to convey complex information in a simple, engaging, and positive manner to diverse audiences.
• Strong interpersonal skills, with the ability to facilitate open communication and collaborate across departments.
• Detail-oriented with strong analytical and problem-solving abilities.
• Proven track record of consistently meeting deadlines and achieving goals.
• Proficient in process improvement and efficiency optimization.
• Strong organizational and leadership capabilities.
• Ability to manage multiple priorities under pressure, ensuring compliance and high service standards.

EDUCATION:

• Associate’s degree in communications, healthcare administration, business management, or a related field.
• Relevant certifications in quality assurance or compliance are a plus.

EXPERIENCE:

• Minimum of 2 years of experience in a role requiring strong written and verbal communication skills.