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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
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