Workforce QA Manager- Remote

Transforming Healthcare through Innovative Solutions

HMS is a pioneering healthcare technology company dedicated to making the healthcare system more efficient, effective, and accessible for everyone. Our mission is to combat fraud, waste, and abuse, ensuring that people have access to quality healthcare now and in the future.

We leverage cutting-edge technology and powerful data analytics to help government and commercial payers reduce costs, enhance quality, and achieve regulatory compliance. Our solutions also empower consumers to take a more active role in their own health, promoting healthier lives.

Each year, we save our clients billions of dollars while contributing significantly to the well-being of individuals and communities. At HMS, you will develop new skills, build your career in a dynamic industry, and make a meaningful difference in the lives of others.

Job Summary:

We are seeking a highly skilled and detail-oriented Workforce QA Manager to oversee vendor operations, workforce management, quality assurance functions, and training initiatives. This role is responsible for ensuring optimal vendor performance, managing inventory and reporting processes, monitoring key performance indicators (KPIs), and implementing quality control measures to enhance productivity and revenue performance.

The ideal candidate will possess strong analytical skills, leadership capabilities, and a proactive approach to operational excellence.

Responsibilities:

Vendor Coordination & Workforce Management:

• Oversight of vendor operations, ensuring alignment with organizational goals and contractual obligations.
• Management of inventory loads and transfers to meet operational requirements, ensuring accuracy through regular audits.
• Maintenance of accurate records of vendor performance and workforce efficiency.
• Onboarding and offboarding of vendor agents, providing training and guidance as needed.
• Hosting weekly office hours for vendor agents to address inquiries and provide support.
• Communication of changes in carrier, provider, or claims processing guidelines to ensure compliance.
• Aid in resolving application, system, and technical issues escalated by vendor agents.

Quality Assurance & Performance Monitoring:

• Conducting regular QA assessments to ensure adherence to company standards and processes.
• Establishment and oversight of quality assurance programs to ensure compliance with industry regulations.
• Identification of deficiencies and recommendation of actionable solutions to enhance team performance.
• Development of quality control measures to improve service delivery and operational efficiency.
• Monitoring of productivity metrics, including quality, efficiency, and revenue generation, to identify areas for improvement.

Reporting & Data Analysis:

• Preparation and distribution of comprehensive reports on inventory status, workforce productivity, and revenue performance.
• Tracking and analysis of KPIs to measure workforce effectiveness and efficiency.
• Development and maintenance of dashboards and reports using Tableau and other tools to provide real-time insights to leadership.
• Utilization of Tableau, Teradata Studio, Deep Sea, other analytic tools, and Daily Reporting for performance monitoring and optimization.
• Analysis of workforce trends and provision of data-driven recommendations for operational improvements.

Leadership Readout & Process Improvement:

• Facilitation of weekly leadership meetings to provide updates on vendor operations, productivity metrics, and revenue performance.
• Presentation of findings, recommendations, and action plans to senior management.
• Creation and maintenance of detailed documentation of processes, workflows, and reporting methodologies.
• Identification of opportunities for process enhancements and leading implementation efforts.

Training & Development:

• Development, implementation, and oversight of a structured training program for new hires to ensure proficiency in company policies, procedures, and job functions.
• Conducting refresher training sessions for existing employees to reinforce best practices and compliance with SOPs.
• Regular updating of training materials and SOPs to reflect changes in regulations, company policies, and industry best practices.
• Facilitation of workshops and skill-building sessions to enhance employee competencies and operational efficiency.
• Collaboration with leadership to identify skill gaps and creation of targeted training initiatives to address deficiencies.
• Maintenance of training records and evaluation of the effectiveness of training programs through assessments and feedback.

Qualifications:

• Bachelor's degree in Business Administration, Analytics, Supply Chain Management, Education, or a related field preferred.
• Proven experience in workforce management, quality assurance, vendor coordination, training, and/or performance monitoring.
• Strong analytical skills with experience in data-driven decision-making.
• Proficiency in SQL, relational databases, Tableau for data visualization and dashboard creation.
• Experience with Tableau, Teradata Studio, Toad, Hyperion (Brio) or similar workforce optimization tools.
• Intermediate proficiency in Microsoft Excel, including pivot tables, VLOOKUP, and basic macros.
• Excellent verbal and written communication skills with the ability to interact effectively with stakeholders at all levels.
• Strong organizational skills, attention to detail, and ability to multitask in a fast-paced environment.
• Experience in developing and facilitating training programs is a plus.

Key Competencies:

• Strategic thinking and problem-solving.
• Adaptability to dynamic and fast-paced environments.
• Ability to work collaboratively across teams and with leadership.
• A proactive approach to identifying and resolving deficiencies.
• Strong facilitation and instructional skills for effective training delivery.

Job Location and Travel Requirements:

Remote - Anywhere in the U.S. 0-20% of travel.

About HMS:

HMS is a leader in healthcare technology, committed to making a positive impact on the lives of individuals and communities. Join us and be part of a team that values innovation, collaboration, and inclusion.

About Gainwell Technologies:

Gainwell Technologies is an industry leader in healthcare technology, dedicated to transforming the healthcare system for the better. We believe in the power of collaboration, innovation, and inclusion to drive growth and make a meaningful difference in the lives of others.

Career Opportunities:

We offer a range of career opportunities for professionals who share our passion for making healthcare more efficient, effective, and accessible. Learn more about our available job openings and join our team today.

Equal Employment Opportunity:

Gainwell Technologies is an Equal Opportunity Employer, committed to creating a diverse, equitable, and inclusive workplace. We celebrate diversity and are dedicated to providing equal employment opportunities to all qualified applicants without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.