Healthcare Quality Analyst

4 days ago


Makati City, National Capital Region, Philippines Imagenet LLC Full time

Direct message the job poster from Imagenet LLC

Recruitment Specialist / Talent Acquisition Specialist

Imagenet Phils. is growing, and we are currently seeking Healthcare Quality Auditor to join our team.

Duties and Responsibilities:

The Healthcare Quality Analyst is responsible for evaluating the performance of Customer Service Representatives handling healthcare-related inquiries and transactions. This role ensures adherence to established quality standards, regulatory requirements (e.g., HIPAA), and company policies. The Quality Analyst identifies areas of strength and opportunities for improvement in CSR performance, providing feedback and coaching recommendations to enhance service quality and customer satisfaction.

Key Performance:

  1. Conduct call monitoring and evaluations: Listen to recorded calls and/or monitor live calls to assess CSR performance based on predefined quality metrics. Document all quality monitoring activities, evaluation results, and feedback provided to Customer Service Representatives.
  2. Provide constructive feedback: Deliver objective and actionable feedback to CSR on their performance, highlighting both strengths and areas for development.
  3. Identify trends and patterns: Analyze quality data to identify trends in CSR performance and areas for improvement at the team and individual levels. Keep abreast of changes in healthcare regulations, compliance requirements, and contact center best practices.
  4. Develop and implement quality improvement initiatives: Contribute to the development and implementation of strategies to improve call quality, customer satisfaction, and operational efficiency.
  5. Calibrate with other quality team members: Work closely with training, operations, and other departments to address performance gaps and improve overall service quality. Perform other duties as assigned.

Qualifications:

  1. At least 2nd year college level.
  2. Minimum 5 years working experience in Healthcare BPO setting.
  3. At least 3 years' experience as a Quality Auditor in a healthcare account.
  4. In-depth knowledge of prior authorization processes, payer/insurance regulations, and industry standards.
  5. Familiarization with healthcare terminologies is a must.
  6. Excellent communication and interpersonal skills, with the ability to communicate effectively with clients, team members, and stakeholders at all levels.
  7. Self-motivated and resourceful with the ability to multitask and successfully operate in a fast-paced, team environment.
  8. Strong analytical skills and attention to detail are essential to identify issues, quantify defects and measure quality improvements.
  9. Ability to perform under pressure in a calm manner & maintain a positive attitude.
  10. Strong organizational skills and ability to adapt well to change and successfully set and adjust priorities as needed.

Requirements:

  1. Willing to work on shifting schedule, graveyard shift, holidays and weekends if required.
  2. Willing to work onsite in Makati
  3. Can start ASAP; this is an urgent hiring.

Additional Benefits:

COMPANY OVERVIEW:

Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans' members and providers.

The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans' members and providers. The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually. The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients.

Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.

Seniority level

Mid-Senior level

Employment type

Full-time

Industries

Business Consulting and Services

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