Clinical Quality Evaluator- Core (PHL)
Carelon Global Solutions Philippines Inc
Full-time
Bio & Pharmacology & Health
Location
taguig, metro manila, Philippines
Posted
June 21, 2026
Job Description
Position Title
Clinical Quality Evaluator- Core (PHL)
Primary Responsibilities
- Evaluate the quality and accuracy of transactions and/or communications with providers, groups, and/or policyholders.
- Identify, document, and report any transaction errors or communication issues in a timely manner to ensure prompt resolution.
- Track and trend audit results, providing feedback to management.
- Conduct calibration sessions to evaluate and ensure all teams are aligned with QA guidelines.
- Identify and report systemic issues that create ongoing quality concerns.
- Conduct root cause analysis using RCA tools to determine underlying causes of quality opportunities.
- Recommend, implement, and monitor preventive and corrective actions to ensure quality standards are achieved.
- Generate monthly reports of audit findings and support clients with identified issues.
- Develop additional reports as requeste...