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The BPO Transaction Quality Assurance Analyst is responsible for reviewing claims transactions and providing feedback to claims processors. This role focuses on improving process efficiency and quality through workflow analysis and business process design. Candidates should have a minimum of 3 years of experience in quality assurance within the insurance sector, particularly in claims processing. Strong analytical skills and proficiency in tools like MS Visio and Excel are essential. The position requires excellent communication skills and the ability to work collaboratively in a team environment.
Job Responsibility:
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
Requirements:
Any Bachelor’s degree
A minimum of 3 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
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
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