Manager, Quality Audit

HealthEdge•Remote,

118d•$99,000 - $109,000•Remote

About The Position

At UST HealthProof, the Manager, Quality Audit supports health plan administration and business process-as-a-service operations focused on reducing administrative costs, improving operational efficiency, and creating better experiences for health plan customers and their members. The role manages operations across a few processes or clients, depending on engagement size, with a typical span of 240–300 associates, and is accountable for meeting service-level agreements (SLAs), driving operational efficiency, and managing engagement or account profitability. The manager works with teams, client contacts, and internal stakeholders to meet operational and quality targets, address process gaps, and develop corrective solutions. The role leads client communications, quality management, team performance, capacity planning, training, process improvement, and complex projects. It also contributes to transition and implementation work, solution design, and identifying opportunities for business growth. The position is remote in the US, with work across time zones and possible travel depending on company needs.

Requirements

10 to 12 years of experience.
Excellent spoken and written English communication and comprehension.
Strong customer focus and ability to build customer confidence through timely, high-quality delivery.
Attention to detail when reporting metrics, quality, and production output.
Ability to analyze information, make fair and well-reasoned decisions, and provide expert opinions on business issues.
Ability to lead, coach, and support teams and guide leads in managing outcomes, expectations, and staff development.
Ability to lead customer conference calls and answer customer questions.
Ability to work under pressure, manage multiple tasks, assess dependencies and risks, and facilitate planning.
Planning skills to translate business objectives into functional activities, set goals and processes, and organize resources.
Ability to estimate and present to clients, estimate project effort based on requirements, and contribute ideas and innovations.
Ability to evaluate test results against product specifications, break down complex problems, and design new systems or reengineer existing systems.
Experience managing clients who are division business heads or vice presidents.
Expertise in work allocation and intake functions.
Familiarity with quality-control processes, including Pareto analysis and root-cause analysis.
Familiarity with Windows operating systems, Microsoft Office, and MS Excel.
Domain knowledge relevant to the process, such as healthcare, banking, investment, finance and accounting, retail, or customer support.
Familiarity with process knowledge and guidelines.
Typing speed of 15 words per minute with 80% accuracy for voice work, or 30 words per minute with 95% accuracy for data work, as applicable.

Responsibilities

Manage operations across processes or clients and ensure committed SLAs and KPIs are met.
Work with teams and managers to achieve quantitative and qualitative performance targets.
Implement measures to improve quality, turnaround time, and process efficiency.
Develop recovery plans with the team and client when targets are missed.
Identify process gaps and collaborate with clients on solutions.
Manage the engagement or account P&L and review the cost effectiveness of proposed solutions.
Participate in solution development for new opportunities and identify potential business growth opportunities.
Create action and remedial plans for transactions; define project productivity standards.
Ensure adherence to quality standards, processes, SOPs, and SLAs; create quality plans and implement quality management functions.
Conduct root-cause analysis and develop corrective and preventive action plans, including after major incidents and escalations.
Manage client relationships, including policy and process updates, documentation and sign-off, SLA waivers and negotiations, status updates, and feedback.
Participate in transition methodology, implementation, and transition of new functions.
Lead customer and vendor calls, organize stakeholder meetings, and manage internal communications and change management.
Manage team and individual performance, set expectations and goals, provide feedback, coach and mentor staff, recognize strong performance, and guide career development.
Plan capacity in response to demand and monitor team output and productivity.
Lead complex projects by breaking them into components, planning execution, and guiding team members.
Monitor support requests and keep users and interested parties informed; escalate issues through established procedures.
Resolve customer and agent problems and address team members' challenges and weaknesses.
Promote process improvement, innovation, automation, and technology solutions that improve service levels, productivity, and delivery.
Coordinate productivity efforts and work with the Quality team to address defects in real time.
Complete mandatory training and certifications, provide on-floor training and one-on-one mentorship, and help new team members understand the customer environment.
Update and track FAST Goals in NorthStar, report progress, and seek continuous feedback from peers and managers.
Consume and share project knowledge and documentation, and develop creative solutions to business challenges.
Make decisions intended to improve revenue generation and customer satisfaction in call handling and call center processes.