Quality Improvement Lead (QIL)

Responsibilities:

Client Engagement & Service Insights:

• Interact with and serve as a point of contact for clients, ensuring clear communication and responsiveness to needs.
• Manage and respond to client email aliases, ensuring timely and professional communication.
• Proactively analyze and identify escalation trends to inform process improvements and enhance client confidence.
• Partner with Operations Transformation teams on implementation planning, remediations, and carrier transitions to ensure seamless service.

Member Experience & Performance Improvement:

• Conduct MSAT (Member Satisfaction) trend analysis, ensuring insights drive action and accountability.
• Perform QA and escalation analysis, tracking trends and recommending interventions without direct issue handling.
• Attend workforce management meetings to align on staffing, service delivery, and operational adjustments.
• Support Advocate Team in performance management decision-making by providing data-driven insights and recommendations.

Quality & Continuous Improvement:

• Support Member Resolution Supervisors/Quality Coaching by facilitating weekly meetings to discuss insights and opportunities.
• Bring trend analysis and findings to weekly quality meetings, ensuring overarching process improvements across the book of business (BoB) and pods.
• Lead process improvement initiatives, leveraging data insights to enhance service quality and operational efficiency.

Data Analysis & Operational Insights:

• Analyze and synthesize data related to member experience and operational performance, providing clear insights and recommendations.
• Identify emerging issues through operational metrics and collaborate with leadership to implement proactive interventions.
• Develop and manage reports on team and pod performance, with a focus on service excellence and member satisfaction.
• Investigate and resolve quality issues, risks, and member feedback trends by developing and tracking corrective action plans.
• Ensure data integrity by collaborating with other quality team members to align reporting and insights.
• Research best practices and external benchmarks to enhance Included Health's service and quality initiatives.
• Support audit remediation efforts and compliance-related quality improvement activities.
• Lead and participate in cross-functional collaborations to improve quality, safety, and service outcomes.
• Perform other duties as assigned.

Qualifications:

• 3+ years of experience in service quality improvement, healthcare operations, or related fields.
• 2+ years of experience creating reports, dashboards, and visualizations to drive performance improvement.
• Bachelor's degree required; CPHQ certification or IHI certification preferred.
• Experience in quality improvement frameworks (e.g., Lean, Six Sigma), root cause analysis, and process optimization.
• Ability to interpret and leverage data to identify trends, test hypotheses, and measure outcomes.
• Strong virtual meeting facilitation skills to drive productive discussions and decision-making.
• Proficiency in Google Apps and Mac OS for developing tools, reports, and dashboards.
• Experience in healthcare settings required; knowledge of member experience metrics is a plus.
• Exceptional organizational and communication skills, with the ability to influence stakeholders and drive cross-functional collaboration.
• Self-starter with a problem-solving mindset and a proactive approach to identifying and implementing improvements.
• Ability to adapt quickly in a dynamic, fast-paced environment while managing multiple priorities.