Quality Analyst

1 Opening

Taguig City

The A&G Intake QA Analyst is responsible for auditing work of agents. This role assists in target training and compiling appropriate and relevant data and feedback for Appeals Intake process. This role also includes calibrating team member to meet best practices for our appeals and grievance department.

RESPONSIBILITIES:

• Perform random internal audits on up to 25% of entry ensuring policy and DLPs are being followed and scoring of agent. Any agent who has a DLP error will be moved to 100% audit until satisfied that target training was successful.
• Assists in the research, analysis, identification, and evaluation of data from assigned problems to evaluate existing and potential trends and issues
• Assists in monitoring initiatives, outcomes, and objectives to ensure goal attainment within defined parameters
• Assists in development of lines of communication to discuss/review results of analysis to management via reports/presentations and assists management in implementing programs that provide solutions on a weekly basis.
• Complete Root Cause Analyst for errors causing missed turnaround times.
  • Assists leadership by investigating, reviewing, and recommending innovative solutions which identify problems/root cause of issues
• Assists with research and correction of authorization rejects
  • Attends and participates in a variety of meetings and committees to provide perspective for a business analysis perspective
• Researches and evaluates data from different sources to identify discrepancies and patterns
• Consults with the operations teams to validate content of reports and documents
• Assists with User Acceptance Testing (UAT) and other implementation tasks as needed
  • Consult on updates to Desktop Level Procedures (DLPs)
• Track and trend patterns in production and monitor Key Performance Indicators (KPIs)
• Internal audit of Appeals and Grievance cases including scoring of team members
• Assist in training new hires and collaborate with team members to retrain identified discrepancies.
• Primary point of contact as subject matter expert for appeals and grievances

QUALIFICATIONS/REQUIREMENTS:

• Bachelor's degree an advantage. Relevant combination of education and experience may be considered in lieu of degree
• 3 years' experience in a related field, typically in at least 2 of the following areas is preferred: financial analysis, planning, health care economics, health care policy, statistical modeling, business decisions, analysis, or business management
• Experience in healthcare
• Experience in Jira and/or Jiva an advantage
• Strong analytical, planning, problem solving, verbal, and written skills to communicate complex ideas
• Ability to work independently within a team environment and communicate effectively with employees and clients at different levels
• Flexibility and ease with changing tasks and priorities
• Ability to perform technical tasks such as creating business requirements documents and user training manuals and guides
• Ability to verify accuracy, consistency, and integrity of data

Healthcare,Appeals,Medical Management

UST is a global digital transformation solutions provider. For more than 20 years, UST has worked side by side with the world's best companies to make a real impact through transformation. Powered by technology, inspired by people and led by purpose, UST partners with their clients from design to operation. With deep domain expertise and a future-proof philosophy, UST embeds innovation and agility into their clients' organizations. With over 30,000 employees in 30 countries, UST builds for boundless impact—touching billions of lives in the process.