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Vida Health is a virtual obesity care provider combining evidence-based treatment with advanced technology and top-notch healthcare providers. The company serves Fortune 100 companies, major national payers, and large providers.
The Quality Compliance & AI Operations Analyst role is an individual contributor position within Vida Member Services, responsible for executing quality assurance initiatives, driving continuous process improvements, and optimizing contact center workflows across omni-channel interactions (voice, chat, email, and AI agents). This is a hands-on role requiring strong cross-functional collaboration, project management skills, and expertise in healthcare compliance, speech analytics, and operational data analysis within a remote healthcare contact center environment.
Key Responsibilities:
- Develop and oversee quality programs ensuring compliance with applicable regulations (HIPAA, CMS).
- Identify and implement training initiatives to enhance service center staff performance based on automated compliance insights and audit trends.
- Track and analyze KPIs to improve patient outcomes, operational efficiency, and service quality.
- Design, build, and continuously tune AWS Auto-QA prompts and rule-building mechanisms (Amazon Connect Contact Lens/Evaluation Features) to flag quality, sentiment, and regulatory compliance risks while minimizing AI hallucination rates.
- Extract, query, and analyze quality interaction logs using SQL via Amazon Athena to build weekly defect reports, CSAT trend analyses, and performance dashboards.
- Oversee Human-in-the-Loop (HITL) QA review workflows, ensuring strict adherence to SLAs (e.g., 24-hour review for Level 1 high-risk incidents) and managing the QA appeals process.
- Facilitate regular QA calibration sessions with leadership and Quality Analysts to maintain scoring consistency across manual and automated evaluations.
- Oversee cross-functional escalation pathways, including potential privacy and security incidents, member complaints to third-party agencies, and internal partner coaching escalations.
- Conduct audits, risk assessments, and root cause analyses to address compliance or quality-related issues.
- Lead efficiency and quality initiatives using Lean, Six Sigma, and other methodologies based on quality findings and regulatory compliance review across all communication channels.
Requirements:
- Bachelor's degree in Healthcare Administration, Business, Quality Management, or related field.
- Minimum 3–5 years of experience in healthcare quality, process improvement, and healthcare technology execution across omni-channel environments (voice, chat, email, and virtual/AI agents).
- Practical experience or strong working knowledge using SQL to query data and build reports (e.g., via Amazon Athena, Looker, or similar tools).
- Hands-on experience with contact center speech analytics, rule-building, or Auto-QA features (e.g., AWS Contact Lens, Genesys, or Zendesk).
- Strong knowledge of healthcare regulatory requirements (HIPAA, CMS) and quality improvement methodologies (Lean, Six Sigma).
- Experience managing Human-in-the-Loop (HITL) audit workflows, SLA tracking, and QA calibration sessions.
- Strong project management skills with experience coordinating quarterly initiatives and implementing operational change.
- Excellent analytical, root-cause problem-solving, and cross-functional communication skills.
Preferred Qualifications:
- Lean Six Sigma certification (Yellow Belt or Green Belt).
- Familiarity with AI/LLM evaluation techniques or prompt tuning in a contact center setting.
- Experience with privacy breach escalation protocols and formal complaint resolution processes (e.g., BBB escalations).
- Familiarity with BI and observability tools such as Looker or DataDog.
