Manager, Quality Audit

About the role

At UST HealthProof, you will join a fast-paced, growing company in our mission to reshape the future of health insurance by significantly reducing administrative costs and building better healthcare experiences for our health plan 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.

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.

Responsibilities

• Work closely with the team and managers to achieve quantitative and qualitative SLAs and KPIs.
• Ensure measures are in place to improve quality, turnaround time, and overall process efficiency.
• Responsible for ensuring the team meets all SLAs and KPIs committed. In case of fallouts, collaborate with the team and client to put a plan in place to get on track and compliant.
• Identify process gaps and collaborate with the client to formulate solutions.
• Focus on managing the P&L for the engagement/account.
• Participate in building solutions for any new opportunities presented.
• Identify opportunities to grow the business and communicate with delivery/sales leaders to pursue them.
• Review the cost-effectiveness of proposed solutions.
• Create and build action plans and remedial plans for transactions.
• Interface with customer and client management: proactively influence customer thought processes, work with clients on policy/process/documentation updates, and handle SLA/waiver/negotiations.
• Proficient in transition methodology and implementation; participate in the transition of new functions.
• Assist in resolving complex process problems by managing and reviewing all aspects of problem management activities, investigating root causes, and recommending SMART solutions.
• Ensure the team handles work received and adheres to SLAs.
• Responsible for creating quality plans and implementing quality management functions.
• Handle reporting and communication with clients and internal team members; provide status updates, obtain feedback, and act on issues immediately.
• Set expectations, manage performance of the team and individuals, provide regular feedback, and coach the team toward operational excellence.
• Perform capacity planning based on increased demand, recognize high performance, and reward accomplishments.
• Review performance reports on team output and productivity; monitor closely.
• Lead customer and vendor calls, organize meetings with stakeholders, and take ownership of internal communications and related change management.
• Make decisions on matters relating to improving revenue generation and customer satisfaction regarding call handling and call center processes.
• Proactively identify opportunities to increase service levels and mitigate delivery issues within or across functions.
• Take accountability for overall productivity efforts, including coordination of function-specific tasks.
• Drive innovation, process improvement, and automation initiatives in partnership with the larger team.
• Make recommendations on improving effectiveness, efficiency, and delivery of services using technology and methodologies.
• Ensure on-time completion of all mandatory training requirements for the organization and customer.
• Provide on-floor training and one-on-one mentorship for new joiners, complete certification of respective career paths, and assist new team members in understanding the customer environment.
• Update FAST Goals in NorthStar, track, report, and seek continuous feedback from peers and managers.
• Set goals for team members and mentees, and provide feedback.
• Lead projects with higher complexity levels, break them into components, plan, and guide team members in effective execution.
• Escalate problems to appropriate individuals/support teams based on established guidelines and procedures.
• Monitor progress of requests for support and ensure users and other interested parties are kept informed.
• Work closely with team members to solve customer problems, understand agents' problems and weaknesses, and address them.
• Perform root cause analysis to find corrective and preventive actions after every process.
• Ensure thorough understanding of organization and customer-defined processes; consult with mentors when in doubt and adhere to defined processes.
• Adhere to organizational policies and business conduct.
• Manage knowledge by consuming project-related documents, SharePoint libraries, and client universities.
• Think outside the box to identify and deliver creative solutions to daily business challenges.
• Focus on planning and execution to ensure quality improvement, turnaround time, and overall process efficiency.
• Promote technical solutions that support business requirements within the area of expertise.
• Regularly interact with the Quality team to ensure real-time action in cases of quality defects.

Skills

• Customer Focus: Provide prompt and efficient service; go out of the way to ensure individual customer needs are met with attention to detail for accurate metrics, quality, and production output reporting.
• Teamwork: Respect others and work well within the team; excellent spoken and written communication in English.
• Analysis and Decision Making: Make judicious and fair decisions after examining all relevant information and making clear assumptions.
• Team Coaching: Lead the team by example, guide and support toward achievement of goals, manage outcomes and expectations, and facilitate aspirations and skill development.
• 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 deliverables on time with quality.
• Capability to estimate and present with clients, contribute to ideas and innovations.
• Planning Skills: Translate business objectives into functional activities, set goals and processes, and organize resources to ensure desired results are met.
• Lateral Thinking: Generate creative solutions to operational challenges, provide expert opinions on business issues, and break down complex problems into logical components.
• Perform and evaluate test results against product specifications.
• Ability to estimate project effort based on requirements, design new systems from scratch, and take up reengineering of existing systems by understanding functionality.

Qualifications

• Familiarity with Windows Operating Systems and 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: 15 WPM with 80% accuracy (Voice) or 30 WPM with 95% accuracy (Data).
• Experience in managing clients who are business heads of divisions/VPs, etc.
• Expertise in customer domain and sub-domain where problems are solved.
• Experience level: 10 to 12 years.

Work Environment

• Remote, US-based role.
• Full-time, permanent position.
• Occasionally required to move around the office.
• Specific vision abilities required include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
• Work across multiple time zones in a hybrid or remote work environment.
• Long periods of sitting and/or standing in front of a computer using video technology.
• May require travel dependent on company needs.

Pay

The annual US base salary range for this position is $99,000 to $109,000. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, skills, experience, qualifications, and education.