BPO Quality Analyst

Job Description:

Review claims transactions and provide feedback to claims processors. Improve process efficiency & quality for existing and new processes through analysis and design of workflows and business processes.

Key Responsibilities:

Review medical documents, policy documents, policy history, claims history, system notes and apply the trained client level business rules to ensure that processors make appropriate Claims decisions, call out claims trends and flag fraud activities.

Developing and maintaining a solid working knowledge of the insurance industry and of all products, services and processes performed by Claims function

Perform functional analysis of the current business process and supporting documentation Identify process improvements and facilitate reengineering of business processes

Create process and value stream map for existing and new business processes

Assist in establishing and maintaining standard operating procedures and knowledge transfer documentation on various functionalities.

Be a team player and work seamlessly with other team members on meeting customer goals.

Key Metrics:

Audit Productivity

Accuracy

Feedback% automated or mistake proofing done.

Qualification:

Any Bachelor’s degree,

Experience:

A minimum of 3-5 years of experience as a Transactional Quality Auditor/MIS specialist/Quality associate involved in implementation of basic Quality framework elements.

Experience with Life Insurance Claims and Policy Administration.

Minimum Skills:

Demonstrates a strong understanding of claims business process redesign/reengineering, gap analysis, functional vs technical specifications, and change management.

Ability to collate data/information from different sources and work on Management Reports without any error.

Strong understanding of claims business process redesign/reengineering, gap analysis, functional vs technical specifications, and change management. Excellent communication skills (written and verbal) to clearly articulate business requirements to technical & development teams.

Knowledge of process mapping tools – MS Visio and Lucid Charts, Excel and Power Point.

Lean Six Sigma

Experience working in an Agile environment.

Experience with Salesforce or other case management systems' modernization.

**Work hours from 9:00 pm to 6:00 am PST (Mon – Fri) from NttData Office at Manila. Additionally, resources may have to do overtime and work on weekend’s basis business requirement."