Quality Program Specialist - Workers Compensation

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.

We’re proud to be recognized—again! For the fourth year in a row, we’ve been certified by Great Place to Work®, and for the third consecutive year, we’ve earned a spot on Fortune's Best Workplaces in Health Care™ list. These honors reflect our unwavering commitment to fostering a positive, inclusive, and employee-centric culture where people thrive.

Watch this short video for a brief introduction to Paradigm.

Are you passionate about improving quality and driving meaningful change? Paradigm is seeking a full-time Quality Program Specialist to leverage data, uncover insights, and support initiatives that enhance operational performance and service excellence. The ideal candidate brings experience in healthcare or workers’ compensation, strong problem-solving abilities, and a commitment to delivering high-quality outcomes for our clients and customers.

The Quality Program Specialist ensures compliance with customer and company quality standards through audits, reporting, issue resolution, and process improvement. This role analyzes quality trends, manages escalations, supports corrective actions, and partners with cross-functional teams to drive continuous improvement and KPI performance.

Job Responsibilities:

• Quality Assurance and Issue Management
  • Conduct quality audits to ensure accurate documentation and process execution.
  • Triage issues and route them to appropriate teams based on complexity and urgency.
  • Monitor process quality and compliance with established standards.
• Escalation Resolution and Collaboration
  • Manage escalated issues through resolution, ensuring timely communication with stakeholders.
  • Partner with internal teams (Referral Management, Network Development, Network Billing, Account Management, Network Services, IT) to resolve complex issues.
  • Serve as a liaison between internal and external stakeholders as needed.
• Root Cause Analysis and Continuous Improvement
  • Perform monthly root cause analysis of recurring issues and escalations.
  • Identify trends and recommend corrective and preventive actions.
  • Support continuous improvement initiatives and process enhancements.
• Reporting and Documentation
  • Develop and maintain KPI, audit, and process-performance reports.
  • Present findings and recommendations to management.
  • Maintain audit records, procedures, training materials, and process documentation.

Qualifications needed for this position:

• Required
  • Bachelor’s degree or equivalent work experience.
  • 2–4 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 leave.management@paradigmcorp.com.

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

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