Quality Assurance Analyst – Customer Care

About Judi Health

Judi Health is an enterprise healthcare technology company that builds a broad set of solutions for employers and health plans. Its ecosystem includes Capital Rx, a public benefit corporation focused on end-to-end pharmacy benefit management for self-insured employers; Judi Health, which provides comprehensive health benefits administration for employers, TPAs, and health plans; and Judi, a proprietary Enterprise Health Platform that brings claim-administration workflows together in one secure, scalable system.

Working with clients, the company aims to restore confidence in U.S. healthcare and strengthen the systems that support better care. Capital Rx, part of the Judi Health family, is a next-generation pharmacy benefits manager serving employers, unions, and government organizations with a mission to modernize prescription benefit pricing and administration. Its platform-led approach uses data and technology to lower costs while improving outcomes.

Role Overview

The Quality Assurance Analyst – Customer Care is focused on improving service quality by reviewing call center interactions, building and maintaining scorecards, and turning QA findings into practical recommendations. The role supports consistent customer experience, compliance with service standards, and ongoing operational improvement across the organization.

What You Will Do

• Work with leadership to create and update customer care quality scorecards that reflect departmental expectations and help measure agent performance.
• Review recorded and live customer conversations and score them according to internal QA standards.
• Check that agents follow procedures, compliance rules, service expectations, and best practices while supporting customers efficiently.
• Take part in calibration discussions with internal teams, external partners, and clients to keep scoring aligned and consistent.
• Support CSAT calibration efforts by partnering with clients and operations teams to improve service experience.
• Study QA metrics and reports to identify patterns, spot improvement areas, and share clear recommendations.
• Prepare performance reporting for supervisors and call center leaders to help drive quality enhancements.
• Identify coaching and training needs from QA results and help new hires understand quality expectations and scoring criteria.
• Manage the full process for member complaints and grievances, including documentation, investigation, and resolution within regulatory, NCQA, and internal timelines.
• Review, document, and research Authorized Representative (AOR) forms accurately and on time to support compliance and operations.
• Complete QA reporting and communication tasks accurately and within required timeframes.
• Follow company policies and regulatory obligations, including HIPAA, patient safety, and data security standards.
• Provide operational support by handling inbound or outbound calls when business needs and service levels require it.
• Escalate compliance concerns or policy breaches to management without delay.
• Carry out additional duties assigned by management within the expected deadlines.

Qualifications

• At least 4 years of experience in call center operations, including 2 or more years in quality assurance or training.
• Experience in PBM or healthcare call center operations is preferred.
• A bachelor’s degree is preferred, though equivalent experience may also be considered.
• Working knowledge of HIPAA and Privacy Rule requirements.
• Familiarity with Medicare.
• Self-directed, customer-focused, and comfortable working in a fast-moving startup environment.
• Ability to create processes and coach frontline customer service teams.
• Strong skill in giving and receiving constructive feedback.
• Well-developed analytical and organizational abilities, with the capacity to work independently and with minimal oversight.

Compensation

The posted base salary range depends on factors such as experience, knowledge, skills, and location.

• Remote, U.S.: $71,200 to $112,000 annually
• New York, NY: $89,600 to $112,000 annually
• Denver, CO: $82,400 to $103,000 annually

Additional Information

All employees must follow the Capital Rx Code of Conduct and are expected to report non-compliance. The company may adjust duties and responsibilities as needed to support organizational goals.

Judi Health is committed to a diverse and inclusive workplace and provides equal employment opportunities regardless of race, color, religion, age, sex, national origin, disability, medical condition, genetic information, veteran status, sexual orientation, gender identity or expression, or other protected characteristics under applicable law.

By applying, you consent to the retention of your personal data for future job consideration. More information about privacy practices is available on the company’s privacy policy page.