[Remote] Quality Assurance Analyst – Customer Care

Note: The job is a remote job and is open to candidates in USA. Capital Rx is a next generation pharmacy benefits manager, determined to transform an outdated model in healthcare. The Quality Assurance Analyst is responsible for evaluating and improving customer care performance by monitoring call center interactions and developing quality scorecards to ensure adherence to customer service standards and operational procedures.ResponsibilitiesCollaborate with leadership to develop and maintain customer care quality scorecards aligned with departmental standards to evaluate agent performanceConduct quality evaluations of recorded and live customer interactions, ensuring scoring aligns with internal Quality Assurance guidelinesAssess agent adherence to procedures, compliance procedures, service standards, and best practices to ensure effective and efficient customer supportFacilitate and participate in calibration sessions within internal teams, external partners, and clients to ensure alignment and consistency in scoringSupport Customer Satisfaction (CSAT) calibration efforts, partnering with clients and operations teams to enhance service qualityAnalyze QA data and reporting to identify trends, uncover improvement opportunities, and deliver actionable insights, trends and agent opportunitiesProvide performance reporting and support to supervisors and call center leadership to drive quality improvementsIdentify training needs through QA evaluations; support new hire onboarding by ensuring clear understanding of quality standards and scoring expectationsOversees the end-to-end processing of member complaints and grievances, ensuring accurate documentation, thorough investigation, and resolution within established regulatory, NCQA, and internal service standardsReview, document, and research Authorized Representative (AOR) forms in a timely and accurate manner to support compliance and operational efficiencyEnsure timely and accurate completion of QA reporting and communication requirementsMaintain strict adherence to all company policies and regulatory requirements, including HIPAA, patient safety, and data security protocolsProvide operational support by handling inbound or outbound calls as needed to support business demands and service levelsReport any compliance concerns or policy violations promptly to managementPerform other duties as assigned by the supervisor or other members of management within the deadlines providedSkills4+ years' experience with call center operations, with at least 2 years of experience with Quality Assurance or trainingKnowledge of HIPAA and Privacy Rule regulationsKnowledge of MedicareA self-starter with outstanding customer service skills and dedication to providing exceptional customer care in a changing, fast-paced startup environmentDemonstrate aptitude to develop processes and coach frontline customer service employeesAbility to give and receive constructive feedbackStrong analytical and organizational skills with an ability to carry out responsibilities with little or no supervisionPBM or Healthcare call center operations experience preferredBachelor's degree preferred, or equivalent experienceCompany OverviewCapital Rx is now Judi Health! Navigate to our new page here: https://www.linkedin.com/company/judi-health It was founded in 2017, and is headquartered in New York, New York, USA, with a workforce of 501-1000 employees. Its website is https://www.judi.health.Company H1B SponsorshipCapital Rx has a track record of offering H1B sponsorships, with 3 in 2026, 3 in 2025, 2 in 2024, 1 in 2023, 1 in 2022, 5 in 2021. Please note that this does not guarantee sponsorship for this specific role.