Healthcare Member Premium Billing Team Lead

We are seeking an experienced and analytical Quality Assurance Lead to oversee and elevate the quality of service in our healthcare call center operations. This role involves supervising QA Analysts, evaluating agent performance, and collaborating with training and operations teams to ensure compliance with healthcare regulations and service standards.

The ideal candidate is experienced in call center QA frameworks, understands healthcare compliance (e.g., HIPAA), and is proficient in using AI-driven quality management tools.

Key Responsibilities:

Quality Oversight & Monitoring

• Lead a team of QA Analysts to assess and score interactions across multiple healthcare call center teams (inbound, outbound, chat, and email)
• Use AI-powered call analytics tools (e.g., speech/text analytics, sentiment analysis) to identify quality trends, coaching opportunities, and process gaps
• Ensure QA evaluations comply with healthcare industry regulations, including HIPAA and internal SOPs
• Maintain and update QA scorecards, calibration sessions, and quality monitoring processes

AI Integration & process Improvement

• Collaborate with AI vendors or internal tech teams to implement and refine AI-based QA tools for automated monitoring and insights
• Analyze AI-generated performance dashboards and derive actionable insights to improve agent performance and patient satisfaction
• Identify and suggest automation opportunities for repetitive QA tasks

Training & Coaching

• Provide feedback and development plans to agents and team leaders based on QA insights
• Lead regular calibration sessions to ensure consistent scoring and feedback
• Assist in training new QA analysts and onboarding them into AI-enhanced QA tools and methodologies

Reporting & Metrics

• Generate regular QA reports and dashboards using both manual and AI-derived data
• Present findings to leadership with recommendations to improve performance and customer satisfaction
• Monitor and ensure alignment with KPIs such as CSAT, FCR, AHT, and compliance adherence

Qualifications:

• Bachelor's degree in Healthcare Administration, Communications, or related field.
• Minimum of 3 years QA experience in a healthcare or BPO call center setting; 1+ year in a lead/supervisory role preferred
• Familiarity with AI tools used in QA (e.g., NICE, Observe.AI, CallMiner, or similar)
• Strong understanding of HIPAA regulations and healthcare communication etiquette
• Experience in data analysis, QA metrics reporting, and performance coaching
• Proficient in QA scorecard design, calibration, and stakeholder communication
• Excellent communication, leadership, and analytical skills

Preferred Skills:

• Certifications in Six Sigma, Lean, or Quality Management an advantage but not required
• Experience with AI implementation projects or digital transformation in customer experience preferred
• Knowledge of healthcare CRM or EMR systems (e.g., Epic, Salesforce Health Cloud)

QA,Healthcare,Analytics