Manager - Quality Excellence

Company : Exl

Job Description - Manager - Quality Excellence

Description

We are looking for a manager – Quality Excellence to set up and lead the quality function for a US Healthcare Client in Kochi. The role will own the quality methodology from transition through steady state, working closely with Operations, Training and client stakeholders.

Expertise in Claims Adjudication, Appeals Review, Contact Center preferred

Responsibilities

Manage the QE team (AMs and QCAs), covering certification, monitoring, feedback and productivity

Drive governance through daily, weekly and monthly quality reporting, RCA and action plans, and client quality reviews

Partner with Operations to improve accuracy, reduce errors and meet client SLAs and P4P metrics

Support the transition by validating SOPs, building quality checkpoints and running UAT, dry runs and go-live readiness

Lead process improvement and standardization projects using Lean Six Sigma tools

Support internal and client audits, interactions and contribute to RFP/RFI responses when needed

Mentor and develop team members

Qualifications

5–7 years of experience in Quality / Process Excellence, preferably in US Healthcare payer processes (claims, Medicare, appeals, prior auth or UM)

Lean Six Sigma Green or Black Belt certification from a reputed organization

Strong grasp of sampling, calibration, RCA and quality metrics

Experience leading QE teams and working with Ops and client stakeholders

Facets or similar claims platform exposure is an advantage

Strong Excel, dashboard and reporting skills; Power BI is a plus

Clear communication, comfortable presenting to leadership and clients

Primary skills (must-have)

Quality Management / Quality Assurance

US Healthcare – Payer

Claims Adjudication

Medicare / Medicare Advantage

Lean Six Sigma (Green Belt / Black Belt)

Root Cause Analysis (RCA)

Audit Sampling and Calibration

Process Improvement

Team Management

Stakeholder Management

Secondary skills (good to have)

Facets

Appeals and Grievances

Prior Authorization / Utilization Management

Transition Management

SOP Development

Power BI / Advanced Excel

P4P / SLA Management

Client Governance and Reporting

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Manager - Quality Excellence

Job Description - Manager - Quality Excellence

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