Quality Analysist Participant Services

Quality Analysist Participant Services at Everise in United States.

Responsibilities

Perform routine quality audits using approved scorecards.

• Evaluate documentation accuracy and policy adherence.
• Prepare weekly and monthly quality reports.
• Provide objective audit feedback to leaders.
• Identify root causes and recurring defect trends.
• Support coaching effectiveness through post-audit validation.
• Monitor daily operational performance against SLA, productivity, quality, and
• schedule adherence goals.
• Ensure compliance with HIPAA, CMS, state board of pharmacy requirements,
• and internal policies.
• Use reporting to identify trends and recommend corrective actions.
• Partner with Workforce Management, Training, Operations, and Leadership.
• Support continuous improvement initiatives and standardization efforts.
• Maintain documentation and confidentiality standards.
• Participate in calibration sessions and business meetings.
• Lead or support special projects as assigned.
• Support non-clinical prescription processing and participant service

workflows.

Requirements

Knowledge, Skills, and Abilities

• Strong written and verbal communication.
• Leadership and relationship-building skills.
• Critical thinking and analytical ability.
• Ability to prioritize competing demands.

Experience working across multiple pharmacy systems.

• Proficiency with Microsoft Office, particularly Excel.
• Ability to maintain confidentiality.

High School Diploma or GED.

• Three or more years of relevant PBM, specialty pharmacy, participant services,

or healthcare operations experience.

• Previous leadership or quality experience appropriate to the role.

Preferred Qualifications

• Active Arizona or Texas Pharmacy Technician License.
• National Pharmacy Technician Certification (CPhT).
• PBM or specialty pharmacy experience.
• Call center healthcare operations experience.
• Lean/Six Sigma or process improvement exposure.
• Experience presenting operational metrics.

Performance Measures

• Quality audit performance
• Productivity and throughput
• Service Level (SLA) attainment
• Attendance and schedule adherence
• Compliance and documentation accuracy
• Customer experience
• Coaching effectiveness and continuous improvement

Work Environment & Physical Requirements

• Fast-paced, computer-based participant services environment requiring prolonged sitting, frequent computer use, telephone communication, and the ability to manage multiple priorities while maintaining accuracy and
• professionalism.
• If you’ve got the skills to succeed and the motivation to make it happen, we look forward to hearing from you.

About the Company

Join us on our mission to elevate customer experiences for people around the world. As a member of the Everise family, you will be part of a global experience company that believes in being people-first, celebrating diversity and incubating innovation. Our dedication to our purpose and people is being recognized by our employees and the industry. Our 4.6/5 rating on Glassdoor and our shiny, growing wall of Best Place to Work awards is a testament to our investment in our culture. Through the power of diversity, we celebrate all cultures for their uniqueness and strengths. With 13 centers around the world and a robust work at home program, we believe great things happen when we work with people who think differently from us. Find a job you’ll love today!