Senior Quality Analyst — Medicare Appeals & Audits

Concentrix Philippines; Philippines; On-site; PHP 300,000 - 600,000; Full time

Job summary

Concentrix Philippines is seeking a quality auditor to monitor and evaluate inbound and outbound calls, chats, and emails, ensuring scoring consistency and adherence to best practices. You will participate in calibration sessions and support audits to improve overall contact quality.

You will provide actionable feedback to nursing and appeals teams, ensure CMS Part C regulatory compliance, and maintain strict confidentiality of member information while documenting resolutions and preparing

Qualifications

• Medical allied graduate with active and valid license.
• Minimum 1 year appeals/grievances experience in Medicare Part C.
• At least 1 year QA in contact center.
• Knowledge of CMS Part C regulatory standards.
• Strong clinical terminology and healthcare insurance knowledge.
• Experience supporting external audits.
• Mentoring new quality staff.
• Attention to detail and documentation skills.

Responsibilities

• Monitor, evaluate, and audit calls and other contact methods.
• Participate in calibration and call listening with stakeholders.
• Contribute to internal quality audits to improve contact quality.
• Meet audit requirements and report results to stakeholders.
• Adhere to CMS guidelines and maintain confidentiality of sensitive member information.
• Document interactions and resolutions in the system.
• Prepare reports to support compliance and auditing.
• Provide feedback to improve processes and regulatory compliance.
• Collaborate with training to identify learning gaps and upskilling initiatives.

Skills

Quality assurance

CMS Knowledge

Healthcare terminology

Auditing

Documentation

Analytical thinking

Education

Licensed medical professional

Tools

MS Office

Quality audit systems

Job description

Concentrix Philippines is seeking a quality auditor to monitor and evaluate inbound and outbound calls, chats, and emails, ensuring scoring consistency and adherence to best practices. You will participate in calibration sessions and support audits to improve overall contact quality.

You will provide actionable feedback to nursing and appeals teams, ensure CMS Part C regulatory compliance, and maintain strict confidentiality of member information while documenting resolutions and preparing