Manager - Quality Excellence

EXL; Ernakulam; On-site; INR 1,500,000 - 2,700,000; Full time

Job summary

EXL in Kochi seeks a Manager – Quality Excellence to set up and lead the quality function for a US Healthcare client. The role owns the quality methodology from transition to steady state, working closely with Operations, Training and client stakeholders.

Responsibilities include managing the QE team, driving quality reporting and RCA, partnering with Operations to improve accuracy and SLAs, leading Lean Six Sigma projects, and supporting audits, transitions and client interactions.

Qualifications

• 5–7 years of experience in Quality / Process Excellence, preferably in US Healthcare payer processes (claims, Medicare, appeals, prior auth or UM).
• Lean Six Sigma Green or Black Belt certification from a reputed organization.
• Strong grasp of sampling, calibration, RCA and quality metrics.
• Experience leading QE teams and working with Ops and client stakeholders.
• Facets or similar claims platform exposure is an advantage.
• Strong Excel, dashboard and reporting skills; Power BI is a plus.
• Clear communication, comfortable presenting to leadership and clients.

Responsibilities

• Manage the QE team (AMs and QCAs), covering certification, monitoring, feedback and productivity.
• Drive governance through daily, weekly and monthly quality reporting, RCA and action plans, and client quality reviews.
• Partner with Operations to improve accuracy, reduce errors and meet client SLAs and P4P metrics.
• Support the transition by validating SOPs, building quality checkpoints and running UAT, dry runs and go-live readiness.
• Lead process improvement and standardization projects using Lean Six Sigma tools.
• Support internal and client audits, interactions and contribute to RFP/RFI responses when needed.
• Mentor and develop team members.

Skills

Quality Management

US Healthcare – Payer

Claims Adjudication

Medicare / Medicare Advantage

Lean Six Sigma Green Belt / Black Belt

Root Cause Analysis (RCA)

Audit Sampling & Calibration

Process Improvement

Team Management

Stakeholder Management

Education

Lean Six Sigma Green Belt or Black Belt certification

Tools

Facets

Power BI

Excel

Job description

Job Description:

We are looking for a manager – Quality Excellence to set up and lead the quality function for a US Healthcare Client in Kochi. The role will own the quality methodology from transition through steady state, working closely with Operations, Training and client stakeholders.

Expertise in Claims Adjudication, Appeals Review, Contact Center preferred

Responsibilities

• Manage the QE team (AMs and QCAs), covering certification, monitoring, feedback and productivity
• Drive governance through daily, weekly and monthly quality reporting, RCA and action plans, and client quality reviews
• Partner with Operations to improve accuracy, reduce errors and meet client SLAs and P4P metrics
• Support the transition by validating SOPs, building quality checkpoints and running UAT, dry runs and go-live readiness
• Lead process improvement and standardization projects using Lean Six Sigma tools
• Support internal and client audits, interactions and contribute to RFP/RFI responses when needed
• Mentor and develop team members

Qualifications

• 5–7 years of experience in Quality / Process Excellence, preferably in US Healthcare payer processes (claims, Medicare, appeals, prior auth or UM)
• Lean Six Sigma Green or Black Belt certification from a reputed organization
• Strong grasp of sampling, calibration, RCA and quality metrics
• Experience leading QE teams and working with Ops and client stakeholders
• Facets or similar claims platform exposure is an advantage
• Strong Excel, dashboard and reporting skills; Power BI is a plus
• Clear communication, comfortable presenting to leadership and clients

Primary skills (must-have)

• Quality Management / Quality Assurance
• US Healthcare – Payer
• Claims Adjudication
• Medicare / Medicare Advantage
• Lean Six Sigma (Green Belt / Black Belt)
• Root Cause Analysis (RCA)
• Audit Sampling and Calibration
• Process Improvement
• Team Management
• Stakeholder Management

Secondary skills (good to have)

• Facets
• Appeals and Grievances
• Prior Authorization / Utilization Management
• Transition Management
• SOP Development
• Power BI / Advanced Excel
• P4P / SLA Management
• Client Governance and Reporting