Claims Quality Audit Lead

Overview

HealthEdge® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an increasingly competitive market. We're experiencing strong market momentum, with a growing number of health plans choosing HealthEdge to modernize their operations and compete more effectively. As we expand, we're investing in the people who power that growth, making this a pivotal moment to join us and shape the future of healthcare technology. Learn more at HealthEdge.com.

 

UST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations that helps our customers achieve affordable, equitable health care for all. We have a strong global presence, with a workforce of over 4,000 people built on a foundation of simplicity, integrity, people-centricity, and leadership.

You Are

UST HealthProof is looking for a Quality Team Lead, reporting to the Quality Group Manager. The Quality Team Lead is responsible for driving excellence in quality, productivity, and data-driven insights across the organization. The Lead will oversee calibration efforts, provide coaching to analysts, and deliver actionable insights that strengthen both operational performance and member experience. In addition, the lead will partner with the leadership team and trainers to identify training opportunities.

The Opportunity

• Calibration & Client Engagement
• Facilitate and lead client calibration calls to ensure alignment on scoring standards and expectations.
• Partner with internal stakeholders to maintain consistent quality scoring practices.
• Analyst Oversight & Productivity Tracking
• Monitor analyst productivity, ensuring 8–10 monthly scorecards per analyst are completed and tracked accurately.
• Maintain scorecard completion compliance and escalate issues impacting productivity or coverage.
• Coaching & Quality Assurance
• Conduct side-by-side reviews and calibrations with analysts to ensure consistent scoring practices.
• Deliver targeted coaching to analysts to reinforce accuracy, consistency, and development opportunities.
• Perform “quality on quality” reviews to validate the integrity of analyst scoring and reporting.
• Speech Analytics & Continuous Improvement
• Prioritize speech analytics initiatives until Cresta is fully implemented across all clients.
• Identify trends and systemic issues through quality reviews and propose solutions to leadership.
• Partner with training and operations teams to close gaps in agent performance and improve member experience.
• Develop, refine, and maintain the quality program that supports a culture of high industry standards.
• Facilitate peer calibration sessions to ensure alignment of scoring standards across team, client, and agents.

What You Need

• 3+ years in quality assurance, performance management, or related call center/business operations environment.
• Strong analytical skills with the ability to interpret data and identify actionable trends.
• Proficiency in MS Excel, reporting tools, and quality monitoring platforms.
• Experience in calibration sessions with clients and/or internal stakeholders.
• Strong organizational and time management skills, with the ability to manage multiple priorities simultaneously.
• Bachelor’s degree in business, Operations, Quality Management, or related field (or equivalent experience).
• Ability to analyze call center data as it relates to quality, report KPIs, and other operations reports and present findings in a structured way
• Capability to convey messages with understanding to multiple levels throughout the organization.
• Attention to detail and accuracy
• Results driven mindset

For this role, we value:

• Excellent analytical, organizational, problem solving, and verbal and written communication skills.
• Ability to work independently, within a team environment, and with multiple priorities/deadlines.
• Ability to contribute to cross-functional, complex process improvement projects and lead limited-scope process improvement initiatives within the Enrollment team.
• Proficient in current industry standard PC applications and systems (e.g., Access, Excel, Word, and PowerPoint).

Geographic Responsibility:  Remote, US

Type of Employment: Full-time, permanent 

Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:  

• The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.  

• Work across multiple time zones in a hybrid or remote work environment. 

• Long periods of time sitting and/or standing in front of a computer using video technology. 

• May require travel dependent on company needs. 

 

The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990.  Candidates may be required to go through a pre-employment criminal background check. 

 

HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities. 

 

#LI-Remote 

 

**The annual US base salary range for this position is $55,000 to $70,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications and education.