Director of Quality and Continuous Improvement, Member Care

This is a fully remote position, open to applicants in United States.

📋 Description

• Take ownership of the Quality evolution roadmap, which includes transitioning from manual, sample-based evaluations to AI-driven scoring, automated coverage, and continuous quality insights.

• Utilize AI, speech analytics, and interaction data to highlight actionable coaching and opportunities for process improvement.

• Create and uphold quality scorecards, evaluation criteria, and calibration standards, facilitating calibration sessions to ensure consistency among evaluators over time.

• Conduct in-depth analyses of quality trends, complaints, and anomalies, producing executive-level reports that offer actionable insights.

• Establish feedback loops that connect quality insights to actions, whether through coaching, training updates, documentation changes, workflow adjustments, or technology needs.

• Execute structured root cause analyses on critical failures, escalations, and trends in member complaints.

• Develop business cases for improvement initiatives, providing clear ROI projections and measurable impacts.

• Pilot and evaluate new processes, workflows, and member interaction scripts prior to scaling; create and uphold SOPs and documentation standards.

• Collaborate with the Member Services leadership team to define and implement a multi-year Quality Assurance and Continuous Improvement strategy aligned with the company's growth objectives.

• Build, lead, and nurture a team of QA analysts and continuous improvement practitioners, including certification pathways, analyst development tracks, and Green/Black Belt mentorship.

• Represent operational excellence in cross-functional forums, presenting findings, risks, and recommendations to executive leadership.

• Advocate for a culture of continuous improvement across Member Services, partnering with Operations, Technology, Product, Training, and Compliance on integrated initiatives.

• Ensure adherence to healthcare regulations (HIPAA, CMS, state requirements), collaborating with Legal and Compliance teams on audit readiness, and leading corrective action plans.

⛳️ Requirements

• 8-10 years of progressive experience in process excellence, quality management, or operational improvement, with 3-5 years in leadership positions.

• Bachelor’s degree in business administration, Operations Management, Healthcare Administration, or a related field.

• Proven application of methodology in a contact center or healthcare services setting.

• Direct experience with quality monitoring, scorecards, contact center analytics, and coaching leaders with documented performance results.

• Practical experience in directing or implementing AI-driven quality tools, speech analytics platforms, or automated scoring systems.

• Proven ability to translate quality analytics into business recommendations for executive audiences.

• Familiarity with healthcare regulations: HIPAA, ACA, CMS, and state insurance compliance requirements.

• Strong executive presence with excellent facilitation, coaching, and communication skills across all organizational levels.

• Analytical mindset with experience in statistical analysis and converting data into actionable operational decisions.

• Bias toward action, rapid iteration, and an entrepreneurial approach to problem-solving.

🏝️ Benefits

• Competitive salary, bonus opportunities, and equity package.

• Comprehensive Medical, Dental, and Vision benefits.

• A 401k retirement plan.

• Paid vacation and company holidays.

• Opportunity to make an impact at a rapidly growing mission-driven company transforming healthcare in the U.S.