Director of Quality and Continuous Improvement

About the Role

We're seeking for a Director of Quality and Continuous Improvement who can lead from both ends of the strategy-to-execution spectrum. The role is structured around two distinct functions: (1) overhauling how we approach quality assurance, leveraging AI and speech analytics to shift from manual, sample-based review to continuous, intelligent insights; and (2) converting those signals into action across the organization — whether through training, documentation and SOPs, or broader cross-functional process improvement.

The right person for this role thrives in both the strategic and tactical – presenting quality trends and risks to executive leadership while rolling up their sleeves to drive improvement initiatives from insight to implementation understanding what “good” looks like and how to build the systems, tools, and team to get there.

Key Responsibilities

Quality Strategy & AI Evolution (40%)

• Own the Quality evolution roadmap, including the transition from manual, sample-based evaluation to AI-powered scoring, automated coverage, and always-on quality insights
• Leverage AI, speech analytics, and interaction data to surface actionable coaching and process improvement opportunities
• Design and maintain quality scorecards, evaluation criteria, and calibration standards – leading sessions calibration sessions to ensure consistency across evaluators and time
• Perform deep-dive analysis on quality trends, complaints, and outliers, generating executive-level reports with actionable insights

Converting Insight into Action (30%)

• Design feedback loops connecting quality insight to action – whether that’s coaching, training updates, documentation changes, workflow updates, or technology needs
• Conduct structured root cause analysis on critical failures, escalations, and member complaint trends
• Build business cases for improvement initiatives with clear ROI projections and measurable impact
• Pilot and test new processes, workflows, and member interaction scripts before scaling; create and maintain SOPs and documentation standards

Team and Stakeholder Leadership (30%)

• Partner with the Member Services leadership team to define and execute a multi-year Quality Assurance and Continuous Improvement strategy aligned to company growth objectives
• Build, lead, and develop 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, present findings, risks, and recommendations to executive leadership
• Champion a continuous improvement culture across Member Services, partnering with Operations, Technology, Product, Training, and Compliance on integrated initiatives
• Ensure compliance with healthcare regulations (HIPAA, CMS, state requirements), partner with Legal and Compliance teams on audit readiness, and lead corrective action plans

Required Qualifications

• 8-10 years of progressive experience in process excellence, quality management, or operations