Manager, Quality Audit

Overview

Overview:

  

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.   

 

Job Profile Summary

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.

 

Job Description

Expectations from this role:1. Works closely with the team and managers to achieve quantitative and qualitative SLAs and KPIs.2. Ensures measures are in place to improve quality, turnaround time and overall process efficiency.3. 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 compliant4. Identifies process gaps and collaborates with the client to formulate solutions5. Focuses on managing the P&L for the engagement / account6. Participates in building solutions for any new opportunities that are presented.7. Identify opportunities to grow the business (if any) and communicate with delivery/sales leader for the group to pursue the opportunity.8. Reviews the cost effectiveness of proposed solution(s).

 

Typical performance measures: 1. Creates and builds action plans and remedial plans for transactions.2. New opportunity identification / solution designing.3. 100% Adherence of team to quality standards, process and SLA’s4. Number of non-compliance issues with respect to SOP5. Zero/No Client Escalations6. RCA and Corrective Action Plans7. Number of high-quality RCA and QA output8. Guides and mentors the junior associates. 9. Delegate tasks and set deadlines for the team10. Defines productivity standards for project

 

Performance Areas: 1. 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. 2. 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.3. Operations: Ensure team handles the work received and adheres to SLAs4. Quality: Responsible for creating quality plans and implement quality management function5. 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 highlighted6. 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. 7. 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.8. 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.9. 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 coord