Quality Program Specialist - Worker's Compensation

Paradigm is seeking a full-time Quality Program Specialist. The Quality Program Specialist is responsible for ensuring quality standards are compliant with customer requirements and consistent with company standards through quality audit processes and regular reporting. This role supports quality assurance through triage, escalation management, cause analysis, and collaboration with cross-functional teams. The specialist will lead monthly reporting of KPIs, document findings, and contribute to continuous process improvement initiatives. The ideal candidate will have strong analytical skills, a background in healthcare or workers' compensation, and experience in quality management and operational problem-solving.DUTIES AND RESPONSIBILITIES:

Quality Assurance and Input Management

Perform quality audits on processes.Triage issues to appropriate teams based on complexity and urgency.Ensure consistent and accurate documentation and Process execution.

Escalation and Problem Solving

Manage and track escalated issues, ensuring timely resolution and stakeholder communication.Collaborate with internal departments (e.g. Referral Management, Network development, Network Billing, Account Management, Network Services, IT) to resolve complex problems.Act as a liaison between internal teams and external when needed.

Root Cause Analysis and Continuous Improvement

Conduct monthly root cause analysis of recurring issues and escalations.Identify patterns and trends to inform ManagementRecommend and support implementation of corrective actions and preventive measures.

Reporting and Documentation

Develop and maintain reports for KPIs, audit results, and process metrics.Present findings to management and contribute to continuous improvement.Maintain documentation of audit, procedures, training materials, and process workflows.

QUALIFICATION REQUIREMENTS:

Bachelor's degree or equivalent work experience.2-4 years of experience in process improvement, operations analysis, or quality improvement.Strong analytical and problem-solving skills.Proficiency in MS Office, especially Excel (pivot tables, charts, formulas).Excellent written and verbal communication skills.Ability to work independently and manage multiple priorities.Preferred:

Experience in healthcare, workers' compensation, or bill review operations.Familiarity with quality management tools (e.g., root cause analysis, PDCA, Pareto charts).Certification in Six Sigma, Lean, or ASQ.