Senior Quality Evaluator

Sr. Quality Evaluator

Job Title:

Sr. Quality Evaluator

Job Description

Concentrix is a technology-enabled global business services company specializing in customer engagement and improving business performance. We partner with ambitious, progressive executives around the world to future-proof their business and stay ahead of the competition and customer expectations.

• Role Summary:
  The Quality Analyst (QA) for Prior Authorization ensures accuracy, compliance, and quality of all PA requests processed by the team. The role focuses on auditing cases, identifying defects, and driving performance improvements.

• Key Responsibilities:
• Audit prior authorization cases for accuracy, completeness, and adherence to payer guidelines.
• Review clinical documentation and decision rationale for compliance.
• Identify quality gaps and provide clear, constructive feedback to associates.
• Maintain QA logs, scorecards, and trend reports.
• Participate in calibration sessions to ensure scoring consistency.
• Recommend process improvements to reduce errors and improve turnaround time.
• Support training needs based on audit insights.

• Required Skills:

• Strong understanding of prior authorization workflows and payer policies.
• Good knowledge of medical terminology and documentation review.
• High attention to detail and analytical skills.
• Effective communication and feedback delivery.
• Experience:

• Prior QA or prior authorization experience preferred.

Educational Qualification : Graduate (B-Pharma)

  Disclaimer:- 'Neither Concentrix nor any authorized 3rd party who assist with our recruitment process, ever ask candidates for ‘recruitment’, ‘processing’ or any other kind of fees in exchange for offer letters from Concentrix. Offer letters and other recruiting correspondence from Concentrix are printed on Concentrix letter head with authentic signatures of appropriate Concentrix authorities.'

Location:

IND Gurgaon - Bld 14 IT SEZ Unit 1, 5th, 6th and 17th Flr

Language Requirements:

Time Type:

Full time

Experience Level

Senior Level