Quality Analyst (Premium Healthcare)

As a Quality Review & Audit Lead Representative you will audit claims for accuracy and compliance with an opportunity for growth and development across multiple audit areas including pre-disbursement.  Our team provides feedback and helps with trend improvement and coaching opportunities for the claims organization. In this role you will have an opportunity to influence the customer journey.Quality Analyst (Premium Healthcare)

Education :
• High School Diploma or GED
• 2+ years claims processing experience using Proclaim with Skill 1, Skill 2 & Skill 3
Experience:
• Complex Claim experience (examples being stop loss and level of care) highly preferred
Mandatory Skills:
• Customer Service Focused: Commitment to exceeding partner and customer expectations
• Critical Thinking: Proven track record in making informed decisions and solving problems effectively.
• Process Improvement: Ability to identify trends and barriers to enhance processes
• Organization Skills: Strong time management and adaptability to multiple or competing priorities
• Communication: Excellent verbal and written communication skills tailored to the audience
•Preferred Skills:
• Experience analyzing and interpreting data and recommending solutions
• Strong analytical and organizational skills preferred
• Detail oriented
• Ability to manage multiple priorities and deadlines
• Excellent communication skills, both written and verbal
• Ability to function in a production environment while maintaining high quality results
• Ability to make sound, independent judgments and decisions
• Ability to influence others through the use of data
• Experience analyzing and interpreting data and recommending solutions
• Strong analytical and organizational skills preferred
• Detail oriented
• Ability to manage multiple priorities and deadlines
• Excellent communication skills, both written and verbal
• Ability to function in a production environment while maintaining high quality results
• Ability to make sound, independent judgments and decisions
• Ability to influence others through the use of data
Roles & responsibilities :
• Conduct Reviews: Ensure our Contact Center advocates adhere to current client policies, procedures, and handle guidelines for calls, chats, and emails, including regulatory and contractual requirements specific to customers
• Tool Proficiency: Utilize and understand the necessary systems and tools for effective quality assurance evaluation process
• Documentation Review: Ensure clarity and consistency in documentation related to reviews including providing feedback for updates when needed
• Quality Assurance: Engage in exercises with peers to provide insight into the review process and maintain high standard of output
• Navigate Systems: Expertly use all Contact Center applications relevant to advocate roles
• Collaborate: Work closely with matrix partners to address gaps and recommend solutions identified through evaluation data
• Continuous Improvement: Represent the quality review organization in various workgroups to enhance workflows, documentation, and issue resolution.
• Support and Educate: Reinforce workflows, processes, and tools for advocates

Quezon City, Bridgetowne GBF TowerPhilippines