Quality Improvement Lead

Summary

Join Included Health as a Quality Improvement Lead (QIL) and transform data into actionable insights to enhance member experience, quality of care, and service excellence. You will help leaders understand member feedback, assess operational performance, and identify opportunities for scalable improvements. The ideal candidate is passionate about service and care excellence and possesses strong analytical skills to translate data into meaningful improvements. This role requires collaboration with leadership to drive data-informed decision-making within a fast-paced environment. You will conduct trend analyses, perform QA and escalation analyses, and lead process improvement initiatives. The QIL will also develop and manage performance reports, investigate quality issues, and ensure data integrity.

Requirements

• 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
• Experience in healthcare settings required
• 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
• 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
• Prompt and regular attendance at assigned work location
• Ability to remain seated in a stationary position for prolonged periods
• Requires eye-hand coordination and manual dexterity sufficient to operate keyboard, computer and other office-related equipment
• No heavy lifting is expected, though occasional exertion of about 20 lbs. of force (e.g., lifting a computer / laptop) may be required
• Ability to interact with leadership, employees, and members in an appropriate manner

Responsibilities

• 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
• 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
• 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
• 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

Preferred Qualifications

• CPHQ certification or IHI certification
• Knowledge of member experience metrics

Benefits

• Remote-first culture
• 401(k) savings plan through Fidelity
• Comprehensive medical, vision, and dental coverage through multiple medical plan options (including disability insurance)
• Full suite of Included Health telemedicine (e.g. behavioral health, urgent care, etc.) and health care navigation products and services offered at no cost for employees and dependents
• Generous Paid Time Off ("PTO") and Discretionary Time Off ("DTO")
• 12 weeks of 100% Paid Parental leave
• Family Building Benefit with fertility coverage and up to $25,000 for Surrogacy & Adoption financial assistance
• Compassionate Leave (paid leave for employees who experience a failed pregnancy, surrogacy, adoption or fertility treatment)
• 11 Holidays Paid with one Floating Paid Holiday
• Work-From-Home reimbursement to support team collaboration and effective home office work
• 24 hours of Paid Volunteer Time Off ("VTO") Per Year to Volunteer with Charitable Organizations