Case Management QC Analyst

Valeris; North Carolina; On-site; USD 52,000 - 76,000; Full time

Benefits offered by this job

Medical, dental, and vision plans

401(k) Retirement Savings Plan with 5%

Paid Time Off and holidays

Career development opportunities

Background check and drug screen

Inclusive workplace culture

Job summary

Valeris is seeking a Case Management Quality Control Analyst to review and evaluate program representatives, ensuring patient experience aligns with FDA and HIPAA standards. The role emphasizes impartial collaboration with leadership, training teams, and client engagement to sustain quality performance.

Responsibilities include monitoring calls, reporting on quality metrics, and maintaining SOP adherence while supporting continuous improvement across the organization.

Qualifications

• High School Diploma or equivalent required.
• 2-3 years of customer service, reimbursement/insurance, healthcare billing, physician office or health insurance processing experience required.
• QA/QC audit experience preferred.
• Quality average of 90% or higher required.
• Intermediate knowledge of FDA regulation of AE/PC and HIPAA guidelines.
• Must be able to work independently in a cross-functional environment.

Responsibilities

• Review and evaluate program representatives on patient experience and regulatory compliance.
• Analyze call trends and partner with internal teams to improve patient experience.
• Maintain understanding of SOPs, processes and policy requirements.
• Prepare and analyze internal quality reports for management.
• Manage disputes and call requests via ServiceNow.
• Support training and calibrations with clients and internal teams.
• Prepare call records and participate in client audits.
• Edit call recordings to remove PHI as required.
• Contribute to quality standards and monitoring forms.

Skills

Customer service

Data analysis

Problem solving

Communication

Time management

Independence

Education

High School Diploma

Tools

MS Office

Call recording software

Monitoring software (Zoom, Calabrio, NICE)

Job description

Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Formed by the merger of PharmaCord and Mercalis, Valeris™ revolutionizes the path from life sciences innovation to real-life impact to build a world in which every patient gets the care they need. Valeris works on behalf of life sciences companies to improve the patient experience so that patients can access and adhere to critical medications. Backed by proven industry expertise, a deep commitment to patient care, the latest technology, and exceptionally talented team members, Valeris provides the data and strategic insights, patient support services and healthcare provider engagement tools to help life sciences companies successfully commercialize new products. Valeris provides commercialization solutions to more than 500 life sciences customers and has provided access and affordability support to millions of patients. The company is headquartered in Morrisville, North Carolina and Jeffersonville, Indiana. To learn more about Valeris, please visit www.valeris.com.

The Case Management Quality Control Analyst is responsible for reviewing and evaluating the performance of the Program Representatives as they complete their cases and represent Valeris Market Access and our clients to patients, providers, and pharmacies.

This position requires the ability to work in a constructive, impartial, and collaborative manner by establishing positive work relationships, partnering with the Market Access Leadership team, Training, and Client base. This position requires the ability to gain the confidence and trust of others by demonstrating professionalism and expertise in an ever-changing environment.

Key Responsibilities:

• Reviews and evaluates the performance of program representatives in the areas of patient experience, Federal Drug Administration (FDA) regulation of Adverse Events (AE)/Product Complaints (PC), Health Insurance Portability and Accountability Act (HIPAA) compliance, and program-specific policies and procedures using an approved quality scorecard.
• Analyzes potential call trends through call monitoring and works with internal departments to develop solutions to improve the patient experience.
• Maintains a thorough understanding of company Standard Operating Procedures (SOPs), processes and policy requirements.
• Prepares and analyzes internal quality reports for management review.
• Manages disputes and call requests received through ServiceNow portal.
• Participates and/or facilitates internal and external calibrations to identify Client’s needs and expectations.
• Facilitates new hire training and introduces program quality standards and expectations.
• Prepares call records and/or corresponding documents and participates in internal and external client audits.
• Handles requests to locate specific call records from the call recording system and provides reports of findings; Edits call recordings to remove Protected Health Information as requested or according to contractual agreements.
• Participates in internal department meetings as needed.
• Contributes to the design of call monitoring forms and Quality standards.
• Identifies and reports pharmacovigilance information as required by client(s) (e.g., Adverse Events).
• Utilize Valeris’ values as the driving force behind the team’s success
• On time adherence to training deadlines for all corporate policies and procedures
• Ensure all SOPs are followed with consistency
• Perform additional tasks or projects as assigned

Qualifications:

• High School Diploma or equivalent required.
• 2-3 years of customer service, reimbursement/insurance, healthcare billing, physician office or health insurance processing experience required.
• QA/QC audit experience preferred.
• Quality average of 90% or higher required (for internal applicants)
• Intermediate knowledge of FDA regulation of AE/PC and HIPAA guidelines
• Must be a motivated self-starter with the ability to work independently and cooperatively within a cross functional environment.
• Must be able to manage priorities while working independently and without direct supervision.
• Must be flexible and have the willingness and ability to respond to changing circumstances and expectations readily, punctually, and reliably.
• Must be able to solve problems and make independent decisions with a high level of confidence.
• Must be able to collect, gather, visualize, and analyze data in detail.
• Ability to be fair and impartial.
• Display a high level of professionalism, integrity, maturity, and maintain a positive attitude.
• Excellent verbal and written communication and interpersonal skills.
• Strong planning, time management, attention to detail and organizational skills.
• Comfortable interacting with all levels of management and personalities.
• Basic knowledge of MS Office (Word, Excel).
• Basic knowledge of monitoring software preferred (e.g., Zoom Call Recording, Calabrio, NICE Call Recording, etc.).
• Must be available for onsite training and/or in-person client meetings as necessary.

Physical Demands & Work Environment

• While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit for long periods of time, use hands to type, handle or feel; and reach with hands and arms. Prefer candidates who can type at least 35 words per minute with 97% accuracy.
• Although very minimal, flexibility to travel as needed is preferred.
• This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, etc.

Why Work for Valeris?

• Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs
• Additional health support, including telehealth and Employee Assistance Program (EAP) services
• Company match on Health Savings Account contributions
• Free Basic Life and AD&D coverage equal to your annual earnings, with a minimum of $50,000 and a maximum of $300,000
• Company-paid Short-Term Disability coverage, with the option to purchase Long-Term Disability
• 401(k) Retirement Savings Plan with 100% match on the first 5% you contribute, with immediate vesting
• Paid Time Off (PTO) and Sick Leave to support work-life balance
• Team members receive nine paid holidays plus two floating holidays
• Opportunities for advancement in a company that supports personal and professional growth
• A challenging, stimulating work environment that encourages new ideas
• Work for a company that values diversity and makes deliberate efforts to create an inclusive workplace
• A mission-driven, inclusive culture where your work makes a meaningful impact

Any offer of employment is contingent upon the successful completion of a background check and, depending on the position, a drug screen in accordance with company standards. Please note that this job description is not intended to be an exhaustive list of all duties, responsibilities, or activities associated with the position. Responsibilities and tasks may be modified at any time, with or without notice.

Our Commitment to Equal Opportunity

At Valeris, we don’t just accept difference – we celebrate it, support it and we thrive on it for the benefit of our employees, our products and our community. Valeris is proud to be an equal opportunity employer.