Quality/Commissions Validation Specialist

General Summary

The Commissions Validation Specialist is primarily responsible for proactively validating carrier commissions and opening commission inquiries with providers each month as part of our monthly commission audit process. This position also provides input and recommendations to team and department management to improve processes related to commission validation.

This role requires a high attention to detail and is expected to scrutinize information / inquiry responses received from providers in accordance with our Provider Agreements. This position requires specialized training, experience and knowledge, and regularly exercises discretion in carrying out the duties associated with this role. This position collaborates closely with other members of the department.

Essential Functions or Responsibilities

Please describe the essential duties and responsibilities which are part of this job. Provide as much detail as necessary to give an accurate, complete picture of the job. Do not list occasional responsibilities which individually consume less than 5% of your time. Next to each duty or responsibility, indicate the approximate percentage of time spent performing each duty. These percents should total to 100%. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

% of - Time Principal Duties or Responsibilities

40% - Validate response to audit commission inquiries

20% - Generate audit commission inquiries

15% - Follow up / re-dispute audit commission inquiries

10% - Performs other related projects or duties as assigned

5% - Coordinate with Service Providers to streamline auditing process

5% - Review and produce regular daily/weekly/monthly reports

5% - Attend and participate in regularly scheduled weekly and monthly meetings

Supervisory Responsibility

Supervisory responsibility refers to direct line control over a group of staff members including such matters such as recruiting and selection, compensation and promotion, performance appraisal and termination.

Decision Making

· This position is responsible for ensuring information is entered accurately into the Company's databases. This includes evaluating and suggesting processes that further support how the Commission Validation Team utilizes the databases.

· Determine when to follow-up, re-dispute, and/or escalate audit commission inquiries for greater discussion and awareness.

· Identify when to address provider related responsiveness issues, or any other delays to reasonable dispute response times.

· Utilize discretion when handling sensitive commission information and when communicating this information to partners or providers.

· Determine which provider responses to prioritize given monthly workload and

· Identify which disputes can be resolved internally and/or with provider resources vs. which disputes need to be sent to providers for review.

· Must identify and communicate with carriers to find solutions to any systemic commission issues identified on the carrier side

Budget Responsibility

Please describe the major financial responsibilities in your job including the budget of expenditures you administer. Include the approximate dollars by category in thousands. (Example: staff salaries $150M)

Ingenuity

Comment on the elements of your position which require creativity, resourcefulness or inventiveness. List examples of original and independent thinking required to originate or develop new methods, programs, techniques or procedures.

• Identify areas for improvement in efficiency/scalability and determine recommendations for innovative enhancements

• Inquire about and utilize provider resources to self-service inquiries where applicable.

• Utilize Microsoft Excel to effectively manipulate data and find more efficient methods of sorting / analyzing information.

Communications

Describe the purpose, extent and frequency of your business contacts, both internal and external.

• Communicate with providers regarding audit inquiries monthly to ensure accurate responses.
• Regularly interface with other internal departments at weekly meetings and to address issues or resolve problems.
• Work closely with Financial Operations teams to ensure proper data capture for comprehensive and accurate audit inquiries. Also, field feedback from teams regarding the completeness and clarity of the audit inquiry records.

Job Specifications

Education

Describe the minimum education and experience required to competently perform your job. This may not be the amount of education and experience you personally have at this time. However, if the organization were looking to fill your job what are the qualifications a person should have. Include any certifications in "other".

If a degree requirement is stated (Associate through Ph.D.) please provide the appropriate academic discipline of field of study.

Experience

Describe the previous experience in addition to the preparation and training you indicated above that you feel is necessary to perform the job competently.

• Bachelor's Degree required

· Minimum 1-year related data quality focused role strongly preferred

Skills and Competencies

List any skills, competencies or work requirements for mental, physical, or other important issues which relate to the job.

· Excellent organizational and time management skills with the ability to independently manage and prioritize workload.

· Must be highly detail, process, and quality oriented with a focus on thoroughness and accuracy.

· Excellent problem-solving skills.

· Outstanding written and oral communication abilities.

· Familiarity with Microsoft Office Suite and advanced Microsoft Excel skills including but not limited to Xlookup, Pivot Tables, advanced formulas and functions.

· Experience with databases and data entry/ data management.

· Must be able to keep calm and perform in a high-pressure, team-oriented atmosphere.

· High level of integrity and discretion with an ability to responsibly handle sensitive and confidential information.

Work Environment

Please describe the typical environment that the job operates in.

· The environment is a typical office environment that works in an open plan space that is shared with colleagues and management.

Physical Demands

Please describe the physical demands that are representative of those that must be met by an employee to successfully perform the essential functions of the job.

• Able to work on a PC and on the phone.
• Ability to talk in person (individually and in groups) and on the phone (if necessary).
• Able to remain calm and focused under pressure.
• Able to lift 30lbs.
• While performing the duties of this job, the employee is regularly required to sit and talk or hear. The employee frequently is required to use hands to finger, handle, or feel. The employee is occasionally required to stand, walk and reach with hands and arms.
• The noise level is usually moderate.
• Ability to learn new material rapidly and incorporate new knowledge into daily work.
• The physical and work environment demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disability to perform the essential functions.

Expected Hours of Work

Please list the normal hours of work for this position.

· Generally, a standard 40-hour workweek.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Send your resume to and tell us why you're the perfect fit for this exciting role

Job Type: Full-time

Pay: Php25, Php35,000.00 per month

Application Question(s):

• Where are you currently residing?
• Are you comfortable to work onsite in Tipolo, Mandaue, Cebu?
• Are you comfortable to work during night shift from 11pm-8am?
• How many years of work experience do you have related to data quality focused role?
• Please describe the major financial responsibilities in your job including the budget of expenditures you administer.
• Do you have supervisory authority?
• If yes, what is your job title and how many number of people you have supervised?
• What is your salary expectation?
• When can you start?

Work Location: In person