Quality Assurance Representative – Medicare & Health Insurance

Quality Assurance Representative – Medicare & Health Insurance

Location: Remote – Philippines

Reports To: Quality Assurance Manager / Operations Director (U.S. Based)

Company: Phil-Am Insurance LLC

Overview:

Phil-Am Insurance LLC is dedicated to delivering exceptional client experiences with every call. We’re seeking a Quality Assurance Representative based in the Philippines to review, evaluate, and coach our U.S.-based Medicare and Health Insurance teams. This role ensures every client interaction meets our standards of excellence, compliance, and care — while helping our agents continuously improve through thoughtful, constructive feedback.

Primary Responsibilities:

• Call Monitoring & Evaluation: Listen to and assess recorded calls from Medicare and ACA (Affordable Care Act) sales and service teams.
• Compliance Oversight: Verify adherence to CMS, HIPAA, and company compliance standards, ensuring proper disclosures, needs analysis, and ethical practices are consistently followed.
• Feedback & Coaching: Provide well-documented, balanced feedback that supports agent growth and reinforces best practices in compliance, communication, and professionalism.
• Quality Reporting: Track performance metrics, identify trends, and escalate recurring issues or training needs to U.S. management.
• Calibration Sessions: Participate in regular QA calibration meetings to maintain scoring accuracy and consistency across the QA team.
• Documentation: Maintain clear, organized QA logs, reports, and audit forms for all evaluated calls.
• Process Improvement: Offer insights to enhance scripts, workflows, and customer experience based on call observations and data patterns.

Qualifications:

• Minimum 2 years of quality assurance or compliance auditing experience in a call center, preferably in Medicare, health insurance, or telesales.
• Strong understanding of CMS and HIPAA requirements (training provided for Medicare-specific compliance).
• Excellent written and verbal communication skills in English.
• Analytical mindset with strong attention to detail — accuracy and fairness are key.
• Ability to provide feedback diplomatically, balancing accountability with encouragement.
• Proficient in QA tools and call review platforms (e.g., Five9, Talkdesk, or similar).
• Comfortable working U.S. business hours (CST/EST) and collaborating with a remote team across time zones.

Preferred Attributes:

• Prior experience in reviewing Medicare Advantage or ACA calls.
• Background in agent coaching, training, or compliance.

What We Offer:

• Competitive pay based on experience, with performance-based incentives.
• Work-from-home flexibility with a supportive, people-first culture.
• Opportunity to grow with a U.S.-based agency known for its commitment to quality, ethics, and agent development.
• Training and advancement opportunities in QA leadership, compliance, or operations support.