QA Team Lead in Erie, Pennsylvania at PROVIDER RESOURCES INC

Position Summary
The QA Team Lead is a working lead within PRI's IDRE quality assurance function. The role splits its capacity roughly evenly between processing a standard QA review caseload and owning subject-matter-expert duties: answering review-related questions, engaging in the rebuttal process with Operations, and calibrating QA reviews across the team. The QA Team Lead also supports the QA Manager on process documentation, data and trend reporting, team cohesion, and internal stakeholder engagement, without holding formal management authority. QA Analysts do not report to the QA Team Lead; all reporting lines run to the QA Manager.

Essential Functions
• Process a standard QA review caseload at approximately 50% of capacity, maintaining accuracy and throughput consistent with QA Analyst production standards
• Serve as subject matter expert on review-related questions for QA Analysts and Operations
• Engage in the rebuttal process with Operations, representing QA's position and reconsidering findings where warranted
• Lead or support calibration sessions to align QA review scoring and judgment across the team
• Support data and trend analysis, producing reports on overall program performance and on specific reviewer, Team Lead, and Manager metrics
• Help create, improve, update, and maintain QA processes, documentation, procedures, and tools
• Support the QA Manager in building team cohesion, communication, and alignment, without formal management authority
• Support the QA Manager in engaging the broader organization and gathering internal stakeholder input for QA
• Flag productivity, quality, and staffing trend signals to the QA Manager
• Maintain QA documentation to CMS and URAC audit-ready standards
• Audit ready at all times

Minimum Qualifications
• 2+ years as a QA Analyst at PRI, or 3+ years of equivalent quality assurance, compliance, or claims/utilization auditing experience in a healthcare or insurance setting, with a demonstrated record of accuracy on production and audit metrics
• Deep knowledge of CMS IDRE quality requirements and URAC accreditation standards
• Demonstrated ability to explain review rationale clearly and defensibly to QA Analysts and Operations stakeholders
• Strong analytical skills; comfortable working with data and trend analysis and producing reports for leadership
• Experience or demonstrated readiness to calibrate review scoring consistency across a team
• No formal people-management experience required; this is a working-lead role, not a supervisory one
• ISO 9001 or equivalent quality management familiarity a plus

This job description is not an employment contract and is subject to change. PRI is an equal opportunity employer.