**Not Applicable****Qualification**:Graduate /Post Graduate - preferably MBA graduates Knowledge of CRM tools & MS office tools- For Medical Management and Provider Services Bachelor's Degree in Nursing (BSN).- For Philippines 34 year college degree preferably related to medical field (as mandated by the project).- For NA High School/Equiv, Associates Degree preferred or equiv work experience.**Responsibility**:**Business / Customer**:- Certify controls laid down by the business to ensure successful audit by client and external party.- Interact with customers (internal / external) and keep stakeholders appraised of the process performance.- Create status reports for customers (internal/external).- Manage and resolve escalations and issues raised by customers and process specialists.- Ensure adherence to Quality norms and procedures.- Identify & drive opportunities not limited to Cost Optimization and Process Excellence to enhance service delivery.- Provide client/process related MI reports.- Interface with the management both in terms of cascading messages from senior management and putting into practice strategy or modifications required for the process based on decisions taken.- Identify & drive opportunities to enhance customer experience.- Anticipate issues and needs of the customer related to the project and address them proactively.- thereby help achieve CSS targets.**For Claims, Medical Management & Provider Services**:- Communicate with the client counterpart on a daytoday basis on daily scorecards.**For NA TM**:- Participate in Customer review / governance meetings to discuss on Service performance, project issues and improvement opportunities.- Anticipate issues and needs of the customer related to the project and address them proactively.- thereby help achieve CSS targets.**Project / Process**:**For Medical Management, RCM and Provider Services**:- Ensure timely completion of tasks assigned to all team members.- Develop SOPs and training Manuals.- Generate periodic performance reports and dash boards for the process.- Capture relevant metrics periodically.- Communicate resource issues to Operation Manager.- Inform the teams of any process updates and document the same.- Review and update domain specifics.**For Provider Services**:- Communicate SLA to enabler functions based on timeframes.- Actively participate in discussions with the Quality / PEX teams to identity process improvements.- Lease with NSS to ensure Telecom connectivity & Proper Working of workstation as per specification.- Lease with Admin for Transportation & all other admin related work.- Lease with HR for on time & quality recruitment.- Track Project Performance Quality & Quantitative Metrics.- Ensure adherence to Quality norms and processes.- Adhere to security practices set by organization.- Maintain confidentiality of all information, policies, and procedures as required by the Health Insurance Portability and Accountability Act (HIPAA) protocols.**For Medical Management and RCM**:- Oversee daily operations, processes to ensure that all quality and efficiency standards and targets are met.- including but is not limited to daily completion rate, accuracy of data encoded in the review, attendance and adherence to company protocols.- Oversee the performance of new on boards and ensures coaching of the team.- Analyze areas for improvement for meeting program objectives and participates in establishing Quality Improvement Projects for the program.- Provide weekly coaching to the team in relation to their scope of work.- Cascade essential information and updates to team through the weekly meetings.- Provide regular and periodic feedback to the Program Manager on the team performance for coaching and appraisal purposes.- Handle staff questions and escalation as necessary.- Perform senior process executive functions as needed.- Supervise the hiring process.- Review all QC and QA reports and reinforce corrections and suggestions made the quality reviews team.- Collaborate with the team and clients and assists the Operations manager with managerial activities as needed.- Reward and discipline employees.- address complaints and resolve problems.- Coach and develop Nurse Reviewers, Administrative Staff, Subject Matter Experts (SME), and Team Lead to promote an understanding of the company culture, policies, goals and procedures.**For Claims, NA, RCM and Member Services**:- Support Knowledge transfer at the time of process transition from the business site.- Drive team to achieve process Service Level Agreements / metrics ie productivity and quality targets within the established timelines.- Ensure compliance controls are met.- Ensure documented process guidelines are followed.- conduct periodical reviews for process adherence.- Conduct adhoc Quality checks.- Review process audit findings and take corrective action.- Innovate ideas to error proof the proce
