HMS makes the healthcare system work better for everyone. We fight fraud, waste, and abuse so people have access to healthcare—now and in the future. Using innovative technology and powerful data analytics, we help government and commercial payers reduce costs, increase quality, and achieve regulatory compliance. We also help consumers take a more active role in their own health. Each year, we save our clients billions of dollars while helping people live healthier lives. At HMS, you will develop new skills and build your career in a dynamic industry while making a difference in the lives of others.
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. Additionally, the Workforce QA Manager will develop and oversee a structured training program for new hires and existing employees, ensuring continuous skill enhancement and compliance with standard operating procedures (SOPs). The ideal candidate will possess strong analytical skills, leadership capabilities, and a proactive approach to operational excellence.
Responsibilities:
Vendor Coordination & Workforce Management:
- Oversee vendor operations, ensuring alignment with organizational goals and contractual obligations.
- Manage inventory loads and transfers to meet operational requirements, ensuring accuracy through regular audits.
- Maintain accurate records of vendor performance and workforce efficiency.
- Onboard and offboard vendor agents, providing training and guidance as needed.
- Host weekly office hours for vendor agents to address inquiries and provide support.
- Communicate 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:
- Conduct regular QA assessments to ensure adherence to company standards and processes.
- Establish and oversee quality assurance programs to ensure compliance with industry regulations.
- Identify deficiencies and recommend actionable solutions to enhance team performance.
- Develop quality control measures to improve service delivery and operational efficiency.
- Monitor productivity metrics, including quality, efficiency, and revenue generation, to identify areas for improvement.
Reporting & Data Analysis:
- Prepare and distribute comprehensive reports on inventory status, workforce productivity, and revenue performance.
- Track and analyze KPIs to measure workforce effectiveness and efficiency.
- Develop and maintain dashboards and reports using Tableau and other tools to provide real-time insights to leadership.
- Utilize Tableau, Teradata Studio, Deep Sea, other analytic tools, and Daily Reporting for performance monitoring and optimization.
- Analyze workforce trends and provide data-driven recommendations for operational improvements.
Leadership Readout & Process Improvement:
- Facilitate weekly leadership meetings to provide updates on vendor operations, productivity metrics, and revenue performance.
- Present findings, recommendations, and action plans to senior management.
- Create and maintain detailed documentation of processes, workflows, and reporting methodologies.
- Identify opportunities for process enhancements and lead implementation efforts.
Training & Development:
- Develop, implement, and oversee a structured training program for new hires to ensure proficiency in company policies, procedures, and job functions.
- Conduct refresher training sessions for existing employees to reinforce best practices and compliance with SOPs.
- Regularly update training materials and SOPs to reflect changes in regulations, company policies, and industry best practices.
- Facilitate workshops and skill-building sessions to enhance employee competencies and operational efficiency.
- Collaborate with leadership to identify skill gaps and create targeted training initiatives to address deficiencies.
- Maintain training records and evaluate 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
Join HMS and be a part of a team that is committed to making healthcare more efficient, effective, and accessible for all.
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#LI-REMOTE
The pay range for this position is $69,400.00 - $99,100.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.
Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment 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. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.
