Quality Program Specialist

Quality Program Specialist

Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has an exceptional track record of generating the very best outcomes for patients, payers, and providers. Deep clinical expertise is the foundation for every part of Paradigm's business: risk-based clinical solutions, case management, specialty networks, home health, shared decision support, and payment integrity programs.

Paradigm is seeking a full-time Quality Program Specialist. The Quality Program Specialist is responsible for ensuring quality standards are compliant with customer requirements and consistent with company standards through quality audit processes and regular reporting. This role supports quality assurance through triage, escalation management, cause analysis, and collaboration with cross-functional teams. The specialist will lead monthly reporting of KPIs, document findings, and contribute to continuous process improvement initiatives. The ideal candidate will have strong analytical skills, a background in healthcare or workers' compensation, and experience in quality management and operational problem-solving.

Duties and Responsibilities:

• Quality Assurance and Input Management
  • Perform quality audits on processes.
  • Triage issues to appropriate teams based on complexity and urgency.
  • Ensure consistent and accurate documentation and process execution.
• Escalation and Problem Solving
  • Manage and track escalated issues, ensuring timely resolution and stakeholder communication.
  • Collaborate with internal departments (e.g. Referral Management, Network Development, Network Billing, Account Management, Network Services, IT) to resolve complex problems.
  • Act as a liaison between internal teams and external when needed.
• Root Cause Analysis and Continuous Improvement
  • Conduct monthly root cause analysis of recurring issues and escalations.
  • Identify patterns and trends to inform management.
  • Recommend and support implementation of corrective actions and preventive measures.
• Reporting and Documentation
  • Develop and maintain reports for KPIs, audit results, and process metrics.
  • Present findings to management and contribute to continuous improvement.
  • Maintain documentation of audit, procedures, training materials, and process workflows.
  • Maintain reliable and predictable attendance during scheduled work hours.
  • Responsible for complying with Paradigm Information Security requirements and policies, for safeguarding Paradigm or Paradigm related passwords, and for notifying Paradigm of any Information Security incidents per policy SEC 10-12 Information Security Incident Management.
  • Demonstrates a customer-first mindset by developing a broad and deep (where appropriate) understanding of Paradigm organization, products, operations, and customers. Prioritizes collaboration to meet customer needs and expectations and takes personal accountability for service quality.
  • Utilizes AI tools to support day-to-day tasks, improve efficiency, and enhance output quality. Adopts new technologies as trained and applies them in alignment with established processes and guidelines.

Qualification Requirements:

• Bachelor's degree or equivalent work experience.
• 24 years of experience in process improvement, operations analysis, or quality improvement.
• Strong analytical and problem-solving skills.
• Proficiency in MS Office, especially Excel (pivot tables, charts, formulas).
• Excellent written and verbal communication skills.
• Ability to work independently and manage multiple priorities.
• Preferred:
  • Experience in healthcare, workers' compensation, or bill review operations.
  • Familiarity with quality management tools (e.g., root cause analysis, PDCA, Pareto charts).
  • Certification in Six Sigma, Lean, or ASQ.

Paradigm Benefits:

• Health and wellness We want our people to be and stay healthy, so we offer PPO, HDHP, and HMO health insurance options with Cigna and Kaiser (CA employees only).
• Financial incentives Paradigm's financial benefits help prepare you for the future: competitive salaries, 401(k) matching contributions, employer-paid life and disability insurance, flexible spending and commuter accounts, and employer-matched HSA contributions.
• Vacation - We believe strongly that work-life balance is good for you and for our company. Our paid time off and personal holiday programs give you the flexibility you need to live your life to the fullest.
• Volunteer time We want our employees to engage with and give back to their communities in meaningful ways. Full and part-time employees receive one paid day per calendar year.
• Learning and development: One of Paradigm's core values is expertise, so we encourage our employees to continually learn and grow. We support this in a variety of ways, including our new Learning Excellence at Paradigm (LEAP) program.

Paradigm believes that fostering a diverse and inclusive workplace is central to our mission of helping more people and transforming lives. We're striving to build a culture that better reflects the society we live in and empowers our team to deliver the highest levels of compassion and care to those we serve. For us, achieving this goal requires a workforce that respectfully embraces differences and commits to positive change, creating an environment where everyone is able to bring their whole self to work.

Paradigm complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact Leave Management at View email address on click.appcast.io.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

As a contractor with the State of Wisconsin, Paradigm complies with Wisconsin Contract Compliance Law (16.765). Poster link: Contract Compliance Law Poster