Sr. Quality Analyst – Clinical Account | Bridgetowne, C5 QC (Night Shift)

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

About the Role

Join our specialized Clinical team as a Sr. Quality Analyst supporting a premier US healthcare provider. In this role, you will evaluate clinical interactions, lead calibration sessions, and drive quality excellence across Utilization Management and Medicare Part C appeals workstreams.

What We Are Looking For

• Education & License: Medical Allied graduate with an active, valid professional license (e.g., PHRN, Registered Pharmacist, Registered Psychometrician).

• Work Experience: Minimum 1 year as a Quality Evaluator/QA in a contact center AND 1 year of experience in Medicare Part C Appeals & Grievances.

• Technical Expertise: Deep knowledge of CMS Medicare Part C regulations, clinical terminology, medical necessity reviews, and audit software/MS Office.

• Core Skills: Strong analytical thinking, sharp attention to detail, experience supporting CMS/external audits, and a background in coaching or mentoring team members.

Key Responsibilities

• Audit inbound/outbound calls, chats, and emails to ensure high standards of contact quality and regulatory compliance.

• Lead calibration and call-listening sessions with operations, quality leads, and client stakeholders.

• Conduct internal quality audits, prepare performance reports, and deliver structured feedback to case coordinators and appeals nurses.

• Ensure strict adherence to CMS guidelines, HIPAA, and company confidentiality protocols.

• Collaborate with Training and Operations to identify skill gaps, provide insights on recurring issues, and support team upskilling.

Ready to take the next step in your clinical healthcare career?