Quality Assurance Analyst – Customer Care

About Judi Health

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including:

• Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers,
• Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and
• Judi®, the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform.

Together with our clients, we’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve.

About Capital Rx

Capital Rx is a next generation pharmacy benefits manager, overseeing prescription benefit plans on behalf of employers, unions, and government entities. Determined to transform an outdated model, Capital Rx’s mission is to change the way prescription benefits are priced and administered in the US, unlocking enduring social change. Through our platform approach, Capital Rx delivers data-driven insights and actionable strategies that reduce costs, while improving patient outcomes. Our commitment to innovation, technology, and service is the reason why Capital Rx is among the fastest-growing PBMs in the country.

Position Summary

The Quality Assurance Analyst is responsible for evaluating and improving customer care performance by monitoring call center interactions, developing quality scorecards, and delivering actionable insights. This role ensures adherence to customer service standards, operational procedures, and regulatory requirements while supporting continuous improvement initiatives across the organization.

Position Responsibilities

• Collaborate with leadership to develop and maintain customer care quality scorecards aligned with departmental standards to evaluate agent performance
• Conduct quality evaluations of recorded and live customer interactions, ensuring scoring aligns with internal Quality Assurance guidelines
• Assess agent adherence to procedures, compliance procedures, service standards, and best practices to ensure effective and efficient customer support
• Facilitate and participate in calibration sessions within internal teams, external partners, and clients to ensure alignment and consistency in scoring
• Support Customer Satisfaction (CSAT) calibration efforts, partnering with clients and operations teams to enhance service quality
• Analyze QA data and reporting to identify trends, uncover improvement opportunities, and deliver actionable insights, trends and agent opportunities
• Provide performance reporting and support to supervisors and call center leadership to drive quality improvements
• Identify training needs through QA evaluations; support new hire onboarding by ensuring clear understanding of quality standards and scoring expectations
• Oversees the end-to-end processing of member complaints and grievances, ensuring accurate documentation, thorough investigation, and resolution within established regulatory, NCQA, and internal service standards.
• Review, document, and research Authorized Representative (AOR) forms in a timely and accurate manner to ensure compliance and accuracy.