Manager, Quality Audit

HealthEdge•Remote,

23h•$99,000 - $109,000•Remote

About The Position

At UST HealthProof, you will join a fast paced, growing company in our mission to reshape the future of health insurance through significantly reducing administrative costs and building better healthcare experiences for our health plans customers and their members. By creating a modern, cloud based, Best-In-Class core administration ecosystem, we have made healthcare more affordable and helped our health plans operate more efficiently. Through member and provider touchpoints with less friction, we have created real impact for members. UST HealthProof is run by leaders with strong health plan and technology backgrounds who have start-up mindsets and an environment of support where individual growth is nurtured. You will be supporting our proven core admin solutions and business process-as-a-service (BPaaS) operations to provide transparency, improve operational efficiency, and break down operational barriers to scale and drive strategic growth.

Requirements

Customer Focus: Focus on providing prompt and efficient service to customers; goes out of the way to ensure that individual customer needs are met.
Attention to detail to ensure metrics, quality and production output reporting is accurate.
Teamwork: Respect others and work well within the team.
Excellent spoken and written communication in English.
Analysis and Decision Making: Makes judicious and fair decisions after examining all relevant information and making clear assumptions.
Team Coaching: Lead the team by example. Guide and support the team towards the achievement of goals.
Coaches and guides Leads in managing outcomes and expectations well. Manage and facilitate aspirations and skill development for team.
Drive conference calls with customers and answer customer questions.
Ability to work under pressure, determine dependencies, risks, facilitate planning and handle multiple tasks.
Build confidence with the customers by meeting the deliverables in time with quality.
Capability to estimate and present with client.
Ability to contribute to ideas and innovations.
Planning skills: Translate business objectives into functional activities. Set goals and processes; organize resources to ensure that the desired results are met.
Lateral thinking: Out of the box thinking to generate creative solutions to operational challenges.
Ability to provide expert opinions to business issues.
Perform and evaluate test results against product specifications.
Break down complex problems into logical components.
Drive conference calls with customers and answer customer questions.
Ability to work under pressure, determine dependencies, risks, facilitate planning and handle multiple tasks.
Build confidence with customers by meeting the deliverables on time with quality.
Capability to estimate and present with client.
Ability to contribute to Idea and innovations.
Ability to estimate project effort based on the requirements.
Ability to design a new system from scratch.
Capability to take up reengineering of existing systems by understanding the functionality.
Manager - Operations, Training, Quality, MIS, Process Excellence.
Leadership role with span of up to 250 FTE.
Familiar with Windows Operating Systems, MS Office.
Excellent English comprehension – reading, writing and speaking.
Domain knowledge based on process (healthcare, banking, investment, F&A, retail, customer support, etc).
Familiarity with process knowledge and guidelines.
Expertise in work allocation and intake functions.
Expertise in MS Excel.
Familiarity with quality control processes including pareto analysis and root cause analysis.
Typing speed with 15WPM and 80% accuracy [Voice].
Typing speed with 30WPM and 95% accuracy [Data].
Experience in managing clients who are business heads of divisions / VPs, etc.
Expertise in customer domain and sub domain where problem is solved.
Experience level – 10 to 12 years.

Responsibilities

Manage all operations for a few processes /clients depending upon the size of the engagement (typical span 240-300 associates) and meet SLAs, drive operational efficiency.
Works closely with the team and managers to achieve quantitative and qualitative SLAs and KPIs.
Ensures measures are in place to improve quality, turnaround time and overall process efficiency.
Responsible for ensuring team meets all SLAs and KPIs committed. In case there are fall outs on meeting targets, the group manager works with the team and client to put a plan in place to get on track and compliant.
Identifies process gaps and collaborates with the client to formulate solutions.
Focuses on managing the P&L for the engagement / account.
Participates in building solutions for any new opportunities that are presented.
Identify opportunities to grow the business (if any) and communicate with delivery/sales leader for the group to pursue the opportunity.
Reviews the cost effectiveness of proposed solution(s).
Creates and builds action plans and remedial plans for transactions.
New opportunity identification / solution designing.
100% Adherence of team to quality standards, process and SLA’s.
Number of non-compliance issues with respect to SOP.
Zero/No Client Escalations.
RCA and Corrective Action Plans.
Number of high-quality RCA and QA output.
Guides and mentors the junior associates.
Delegate tasks and set deadlines for the team.
Defines productivity standards for project.
Interface with Customer and client management: Proactively influence customer thought process. Work with client on policy/process/documentation; updates and sign off. Handles any SLA / waiver / negotiations with the client. Proficient in transition methodology and implementation. Participate in transition of new functions.
Assists others in resolving complex process problems: Manage and reviews all aspects of problem management activities, investigating the root cause of problems and recommends SMART (specific, measurable, achievable, realistic, timely) solutions.
Operations: Ensure team handles the work received and adheres to SLAs.
Quality: Responsible for creating quality plans and implement quality management function.
Communication: Responsible for reporting and communication with client and internal team members. Reviews and communicates with clients daily and provide status update, obtains feedback and acts immediately on any issues highlighted.
Team management: Set expectations; manage performance of team and individuals. Provides regular feedback. Coach team towards operational excellence. Perform capacity planning based on increased demand. Recognize high performance and reward accomplishments. Reviews the performance reports on team output and productivity; closely monitoring the same.
Stakeholder Management: Lead the customer and vendor calls. Organize meetings with different stake holders. Take ownership for function's internal communications and related change management.
Decision Making: The ability to make decisions on any matters relating to improving revenue generation and customer satisfaction with regards to call handling and call center processes.
Process/efficiency Improvement: Proactively identify opportunities to increase service levels and mitigate any issues in delivery within the function or across functions. Take accountability for overall productivity efforts within the function, including coordination of function specific tasks. Innovation/process improvement / automation initiatives in partnership in the larger team. Make recommendations on how to improve the effectiveness, efficiency and delivery of services using technology and methodologies.
Training: On time completion of all mandatory training requirements of organization and customer. Provide on floor training and one on one mentorship for new joiners. Complete certification of respective career paths. Assist new team members in understanding the customer environment.
Performance Management: Update FAST Goals in NorthStar, track, report and seek continuous feedback from peers and manager. Set goals for team members and mentees and provide feedback.
Management: Able to make decisions on any matters relating to improving revenue generation and customer satisfaction with regards to call handling and call center processes.
Leading Projects with higher complexity levels: Lead projects which have a high degree of complexity, break down into components; plan and guide the team members in effective execution.
Escalation: Escalate problems to appropriate individuals/support team based on established guidelines and procedures.
Monitoring: Monitors progress of requests for support and ensures users and other interested parties are kept informed.
Issue Resolution: Work closely with team members to solve customer problems. Understand agent's problems and weaknesses and address. Perform root cause analysis to find corrective and preventive actions after every major incident and escalation.
Process Adherence: Thorough understanding of organization and customer defined process. Consult with mentor when in doubt. Adherence to defined processes. Adhere to organization’s policies and business conduct.
Manage knowledge: Consume project related documents, share point, libraries and client universities. Thinks outside the box to identify and deliver creative solutions to daily business challenges.
Increase productivity: Focuses on planning and execution to ensure quality improvement, turnaround time and overall process efficiency. Promote technical solutions which support the business requirements within the area of expertise. Identifies process gaps and collaborates with the client to formulate solutions. Regularly interacts with the Quality team to ensure real time action in cases of quality defects.