Job Description

JOB DESCRIPTION Role Proficiency: A Voice Lead Able to take customer support calls effectively and efficiently resolve the issue handle escalated calls perform call quality monitoring and reporting and coach team towards meeting SLAs.rnA Data Lead Able to process complex transactions resolve queries from team and clarify complex scenarios while ensuring that quality of output and accuracy of information is maintained in alignment with SLAs. Outcomes: With the right coaching and supervision a lead will be able to do the following: Service Level Agreement (SLAs) specified by the Client in terms of quality productivity and schedule should be managed to ensure 100% adherence for self as well as team. Voice: Monitor (live and remote) cases and give effective feedback to close transactions. Data: Perform QC and QA to ensure process and output quality giving feedback to associates to ensure smooth functioning Manage and maintain process updates and clarification trackers for effective reporting and tracking of transactions. Address any problems with the supervisor/QA to ensure maximum productivity and efficiency. Closely monitor day to day operations of self and team to ensure utilization and minimize errors. Review automation ideas from the team to increase and improve operational efficiency use solutioning mindset to innovate new ideas for the same. Measures of Outcomes: 100% Adherence to quality standards process and SLA\'s Number of issues fixed/tasks completed Number of non-compliance issues with respect to SOP Zero/No Client Escalations % of QC and QA scores RCA and Corrective Action Plans Daily/weekly performance reporting Number of high-quality RCA and QA output Mentors A band associates. Outputs Expected: Production: Take calls (voice) or process complex transactions (data) Quality: Perform quality control of transactions processed by associates SME role: Clarify questions on processes guidelines etc to associates as required Reporting: Create reports on specific SLAs/performance measures/KPIs. Track records daily weekly and monthly to ensure efficient and error free reporting to clients. Management: Set clear team goals and delegating tasks setting deadlines for internal teams. By means of RCA huddles training needs analysis and corrective action plans ensure improvement of quality scores. Recognize high performance and reward accomplishments. Motivate team members on a continuous basis to maintain the morale and effectiveness of the team. Take steps to improve performance based on coaching Training: Discover training needs and provide coaching to the teams. Attends one on one need-based domain/project/technical trainings as needed. On time completion of all mandatory training requirements of organization and customer. Provide on floor training and one on one mentorship for new joiners. Provide coaching training and guidance to new team members to engage and build productivity of team. Issue Resolution: Listen to team members\' feedback and resolve any issues or conflicts. Work closely with team members to solve customer problems. Understand agent\'s problems and weaknesses and address Identifies analyses and solves the incidents/transactions. Perform resolution exercises and quality calibration with clients and ensure 100% participation. Adherence: Aware of any clients process product and updates and ensure 100% compliance towards the same. Adhere to release management process. Thorough understanding of organization and customer defined process. Consult with mentor when in doubt. Adherence to defined processes. Adhere to organization\' s policies and business conduct. Escalation: Escalate problems to appropriate individuals and support team based on established guidelines and procedures. Monitoring: Monitors progress of requests for support and ensures users and other interested parties are kept informed. Manage knowledge: Consume project related documents share point libraries and client universities. Mentor: Mentoring and providing guidance to peers and junior associates. Assist new team members in understanding the customer environment Communication: Provide status update to the respective stakeholders and within the team Collaboration: Collaborate with different towers of delivery for quick resolution (within SLA) document learnings for self-reference. Actively participate in team/organization-wide initiatives. Collaborate with other team members for timely resolution of errors. Skill Examples: Customer Focus: Focus on providing a prompt and efficient service to customers goes out of the way to ensure that individual customer needs are met. Attention to detail to ensure team follows SOPs and does not make unintentional errors Team Work: Respect others and work well within the team. Communication: Speak clearly and write in a clear and concise manner. Uses appropriate style and language for communication (Data) Communication: Speaks in an accent neutral manner or with the accent required for the process with good vocabulary and grammar skills. Writes clearly (Voice) Typing Speed with 15WPM and 80% accuracy Analysis and Decision Making: Makes systematic and rational judgments based on information and relevant assumptions. Makes rule based and discretionary decisions Team coaching on errors: Provide feedback on QA errors perform root cause analysis and create corrective action plans. Excellent communication and leadership skills. Organizational and time management skills. Ability to follow SOP documents and escalate the alerts within the defined SLA. Willingness and ability to learn new skills domain knowledge etc. Team Leader/Sr. Domain Expert/Training Lead/QA Lead/MIS Lead/Process Excellence Lead Supervisors Domain Experts Six Sigma - Green Belt Knowledge Examples: Familiar with Windows Operating Systems MS Office English comprehension - Reading writing and speaking Domain knowledge based on process (healthcare banking investment F&A retail customer support etc) Expertise in process knowledge and guidelines Expertise with work allocation and intake functions Expertise in MS Excel Expertise in quality control processes including pare to analysis and root cause analysis Excellent understanding of customer infrastructure ability to co-relate failures Experience level - 5 to 9 years Additional Comments: Supervisor, Grievances and Appeals Who we are: At UST HealthProof, you will join a fast paced, growing company in our mission to reshape the future of health insurance through significantly reducing administrative costs and building better healthcare experiences for our health plans customers and their members. By creating a modern, cloud based, Best-In-Class core administration ecosystem, we have made healthcare more affordable and helped our health plans operate more efficiently. Through member and provider touchpoints with less friction, we have created real impact for member. UST HealthProof is run by leaders with strong health plan and technology background with a start up mindset and an environment of support where individual growth is nurtured. You will be supporting our proven core admin solutions and business process-as-a-service (BPaaS) operations to provide transparency, improve operational efficiency, break down operational barriers to scale and drive strategic growth. Job Summary: UST HealthProof is searching for a Supervisor for Appeals who will be accountable for processing and reporting all grievances and appeals to the highest quality possible and for ensuring that grievances and appeals are resolved timely and within all regulatory frameworks. This position ensures that all decisions made are accurate and complete and is responsible for developing and reporting all trends for management reporting. Additionally, this role ensures that all Grievance and Appeals policies and procedures are compliant with CMS requirements. As the Appeals Supervisor at UST HealthProof, this is your opportunity to: . Develop and implement effective strategies that enables the department to maintain efficient and cost-effective processes. . Establish operational vision and obtains approval from with senior management relative to grievances and appeals. . Establish and maintain Grievance and Appeals processes and systems to ensure data quality to support UST HealthProof\'s quality, production, and financial goals. . Drive operational excellence into all processes and departmental interactions based on CMS and UST HealthProof\'s requirements. Lead employees and other management in developing effective intercompany workflows for the Grievance and Appeals processes. . Lead, coach, develop, and implement training programs to ensure staff competence. . Operate a departmental audit/oversight program that focuses on continuous quality improvement. . Establish regular reporting to ensure senior management is aware of Grievance and Appeals trends. . Establish a positive working environment that promotes collaboration, transparency, and employee engagement. . Identify innovative methods to improve performance and provider/customer satisfaction. . Instill quality commitment value in the Grievance and Appeals team. . Lead standards and process for insuring quality selection and retention of department employees. . Responsible for balancing workload to optimize the effectiveness of the department. . Directly supervises exempt and non-exempt staff in accordance with company policies and applicable Federal and State Laws. Responsibilities include, but are not limited to, effectively interviewing, hiring, terminating, and training employees planning, assigning, and directing work appraising performance rewarding and counseling employees addressing complaints and resolving problems supporting and encouraging the engagement process. You bring: . Bachelor\'s degree in a related field. Relevant combination of education and experience may be considered in lieu of degree. . Three to five years\' experience of progressive responsibility in an insurance or managed care environment. One year supervisory or lead experience in insurance or managed care is required. . Experience in Grievance and Appeals or Customer Service in a managed care or insurance environment is preferred. . Bilingual skills preferred. . Proven problem-solving skills and ability to translate knowledge to corporate departments. . Knowledge of the Grievance and Appeals regulations per CMS. . Ability to establish training programs and motivate employees in a quality minded environment. . Strong leadership skills with the ability to mentor staff and develop teams. . Ability to work with and empower others on a collaborative basis to ensure success of unit team. . Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions, and employing active listening techniques. . Ability to effectively present budgetary and/or cost information and respond to questions as appropriate. . Ability to establish workflows, manage multiple projects, and meet necessary deadlines. Role Location: Remote

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