Location
Jaipur | India
Job description
Job Description
Position Summary
Claims Prep Quality Analyst conducts audits on the Group Life Claims - Claim Prep process.
The auditor should be a SME on Life Claims - Claims prep process with hands-on experience in the process before becoming a QA.
The process begins post Claims Operations/Claim Prep Cases are completed by Operations and randomly frozen for QA Review.
Claims prep quality auditor will utilize the information tracked on the TrustFlow and make random selections to audit the various transactions.
Audit entries for review are then entered into Team Think audit repository tool
Once completed, audits/associated quality reports shared with the Claims Operations / Organization
QA work quality is assessed by the GOSC Supervisor and onshore QA leader through rebuttals, audit the auditor reviews and team calibration sessions.
Job Responsibilities
1. Essential Functions
Claims Prep Quality executives are responsible for
- Excellent written and verbal communication skills
- Ability to comprehend English language
- Excellent knowledge of Insurance & Life Claims fundamentals
- Evaluate Group Life Claim Prep business processes.
- Improve associate performance by effectively conducting a statistically valid sample of quality evaluations for a moderate to complex set of operational transactions.
- Conduct quality inspections, reviews and assessments for Group Life Claim Prep processes and transactions.
- Collect, analyze, and use quality control to diagnose root causes and recommend corrective action plans.
- Identify trends and improvement opportunities.
Primary Internal Interactions
- AM for the purpose of reporting performance, clarifying concerns, and seeking feedback and support.
- Manager for the purpose of settling issues left unresolved by the AM and monthly evaluation of performance.
- Trainers for the purpose of process training.
- Associates for handling day-to-day execution of transactions and process activities with respect to the process.
Primary External Interactions
External interactions is required
- Onshore Quality Manager for the purpose of auditor reviews and team calibration sessions
Knowledge, Skills and Abilities
Education
- Bachelor's degree (Any Stream) with a minimum of 15 years of education.
Experience
NA
Knowledge and skills (general and technical)
- Strong knowledge of Group Life Claim Prep operational transactions and processes
- Strong analytical and problem-solving skills
- Strong communication and job coaching skills.
- Must demonstrate professionalism, ability to accept and deliver feedback and strong conflict resolution skills.
- Keyboarding and data entry speed (minimum 30 wpm with 90% accuracy)
- Demonstrated flexibility as per process requirement.
- Basic knowledge of MS Excel (Pivot, filter, special paste)
- Proficient in e-mail management
Other Requirements (licenses, certifications, specialized training - if required)
Working Relationships
Internal Contacts
(and purpose of relationship):
- AM for the purpose of reporting performance, clarifying concerns, and seeking feedback and support.
- Manager for the purpose of settling issues left unresolved by the AM and monthly evaluation of performance.
- Trainers for the purpose of process training.
- Associates for handling day-to-day execution of transactions and process activities with respect to the process.
External Contacts
(and purpose of relationship) - If Applicable
- External interactions is required - Auditor will be engaged with the onshore QA team members and the Claim Prep associates and onshore QA Manager
Job tags
Salary
