Clinical QA Lead: Medicare Part C & Audits

Concentrix Philippines; Philippines; On-site; PHP 600,000 - 900,000; Full time

Job summary

Concentrix Philippines is seeking a Sr. Quality Analyst to join our clinical team supporting a premier US healthcare provider.

You will evaluate clinical interactions, lead calibration sessions, and drive quality across Utilization Management and Medicare Part C appeals workstreams. The ideal candidate is a Medical Allied graduate with an active license, has QA experience in a contact center, and strong CMS knowledge.

Qualifications

• Medical Allied graduate with an active, valid professional license (PHRN, Pharmacist, or Psychometrician).
• Minimum 1 year as QA in a contact center and 1 year in Medicare Part C Appeals & Grievances.
• Deep knowledge of CMS Part C regulations and clinical terminology.
• Experience supporting CMS/external audits; ability to coach peers.

Responsibilities

• Audit calls, chats, and emails to ensure quality and compliance.
• Lead calibration and call-listening sessions with stakeholders.
• Prepare performance reports and deliver feedback to coordinators and nurses.
• Ensure CMS, HIPAA, and confidentiality requirements are followed.
• Collaborate with Training and Ops to identify skill gaps and upskill the team.

Skills

Analytical thinking

Attention to detail

Coaching

CMS Part C experience

Audits/regulatory

Education

Medical Allied graduate

PHRN

Registered Pharmacist

Registered Psychometrician

Tools

Audit software

MS Office

Job description

Concentrix Philippines is seeking a Sr. Quality Analyst to join our clinical team supporting a premier US healthcare provider.

You will evaluate clinical interactions, lead calibration sessions, and drive quality across Utilization Management and Medicare Part C appeals workstreams. The ideal candidate is a Medical Allied graduate with an active license, has QA experience in a contact center, and strong CMS knowledge.