Quality Assurance Specialist

CF Solutions Philippines Inc.; Philippines; On-site; PHP 600,000 - 800,000; Full time

Job summary

CF Solutions Philippines Inc. is seeking a quality assurance professional to drive audits and improvements across Enrollment, Eligibility Verification, Insurance Validation, and Care Management workflows in a healthcare operations setting.

The role focuses on calibration sessions, root cause analysis, coaching, and developing QA scorecards, with collaboration across Operations leadership to elevate quality outcomes.

Qualifications

• Minimum 2 to 3 years of healthcare operations experience.
• At least 1 year of QA, Auditing, Compliance, or Performance Improvement experience.
• Experience auditing Enrollment, Eligibility Verification, Insurance Validation, and Care Management workflows.
• Experience conducting root cause analysis and calibration sessions.
• Strong analytical and reporting skills.

Responsibilities

• Audit transactions, calls, cases, and documentation.
• Perform quality reviews against SOPs and client standards.
• Conduct calibration sessions with operations and training teams.
• Identify trends and performance risks.
• Provide coaching recommendations.
• Develop QA scorecards and audit tools.
• Track compliance and productivity metrics.
• Partner with Operations leadership to improve quality outcomes.

Skills

Quality Assurance

Auditing

Compliance

Performance Improvement

Root cause analysis

Calibration sessions

Advanced Excel

Reporting skills

Project management

Job description

Experience

• Minimum 2 to 3 years of healthcare operations experience.

• At least 1 year of Quality Assurance, Auditing, Compliance, or Performance Improvement experience.

• Experience auditing Enrollment, Eligibility Verification, Insurance Validation, and Care Management workflows.

• Experience conducting root cause analysis and calibration sessions.

Technical Knowledge

• Knowledge of:

  • Medicare and Medicaid guidelines

  • Commercial insurance verification standards

  • Healthcare documentation requirements

  • Care Management workflows

  • HIPAA and confidentiality standards

• Strong analytical and reporting skills.

Key Responsibilities

• Audit transactions, calls, cases, and documentation.

• Perform quality reviews against SOPs and client standards.

• Conduct calibration sessions with operations and training teams.

• Identify trends and performance risks.

• Provide coaching recommendations.

• Develop QA scorecards and audit tools.

• Track compliance and productivity metrics.

• Partner with Operations leadership to improve quality outcomes.

Preferred Metrics Experience

• Quality scores

• Audit accuracy rates

• Compliance adherence

• Error reduction trends

• Corrective action effectiveness

• Process improvement initiatives

Preferred Leadership-Level Competencies

Required

• Healthcare BPO or Healthcare Operations experience

• Strong understanding of Enrollment & Eligibility functions

• Knowledge of Care Management Services workflows

• Advanced Excel and reporting skills

• Project management capabilities

• Experience creating and maintaining SOPs

Preferred

• Lean Six Sigma Yellow Belt or Green Belt

• Certified Professional in Healthcare Quality (CPHQ)

• Certified Trainer designation

• Experience building quality and training programs from the ground up