Quality Compliance & AI Operations Analyst

 

 

 

The Quality Compliance and AI Operations Analyst for Vida Member Services is responsible for executing quality assurance initiatives, driving continuous process improvements, and optimizing contact center workflows across omni-channel interactions. This individual contributor role requires strong cross-functional collaboration, project management skills, and hands-on expertise in healthcare compliance standards, speech analytics, and operational data analysis within a remote healthcare contact center environment.

Develop and oversee quality programs to ensure compliance with all applicable regulations (e.g., HIPAA).

Identify and implement training initiatives to enhance service center staff performance and quality 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 actively 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 assessment, and root cause analyses to address compliance or quality-related issues.

Lead efficiency and high quality initiatives using Lean, Six Sigma and other methodologies based on quality findings, and regulatory compliance review across all channels of communication such as voice, chat, email and AI agents.

Additional responsibilities as needed. 

Bachelor’s degree in Healthcare Administration, Business, Quality Management, or a 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 (e.g., 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.

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.

 

 

 

We do not accept unsolicited assistance from any headhunters or recruitment firms for any of our job openings. All resumes or profiles submitted by search firms to any employee at Vida in any form without a valid, signed search agreement in place for the specific position will be deemed the sole property of Vida. No fee will be paid in the event the candidate is hired by Vida as a result of the unsolicited referral.

 

 

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