BPO Quality Analyst

NTT DATA, Inc.; Manila; On-site; PHP 420,000 - 660,000; Full time

Job summary

NTT DATA, Inc. is seeking a transactional quality auditor to review claims processes and ensure accurate decisions. You will analyze medical and policy documents, flag fraud indicators, and provide actionable feedback to claims processors.

The role requires 3–5 years in quality or MIS within Life Insurance, and a strong grasp of process redesign, gap analysis, and change management. Office-based roles in Manila with potential overtime.

Qualifications

• Minimum 3–5 years of experience as a Transactional Quality Auditor/MIS specialist/Quality associate involved in basic quality framework elements.
• Experience with Life Insurance Claims and Policy Administration.
• Strong understanding of claims business process redesign/reengineering, gap analysis, functional vs technical specs, and change management.

Responsibilities

• Review medical and policy documents, claims history, and system notes to ensure correct claims decisions.
• Identify trends, flag fraud activities, and provide feedback to claims processors.
• Develop and maintain knowledge of the insurance claims domain and related processes.
• Perform functional analysis of processes and create process/value stream maps for current and new processes.
• Assist in establishing standard operating procedures and knowledge transfer docs.
• Collaborate with team members to meet customer goals.

Skills

Lean Six Sigma

Agile methodologies

Strong communication

Tools

MS Visio

Lucid Charts

Excel

PowerPoint

Salesforce

Job description

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Review claims transactions and provide feedback to claims processors. Improve process efficiency & quality for existing and new processes through analysis and design of workflows and business processes.

Key Responsibilities:

• 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.

Key Metrics:

• Audit Productivity
• Accuracy
• Feedback% automated or mistake proofing done.

Qualification:

Experience:

• A minimum of 3-5 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.
• Strong understanding of claims business process redesign/reengineering, gap analysis, functional vs technical specifications, and change management. 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.

Work hours from 9:00 pm to 6:00 am PST (Mon – Fri) from NttData Office at Manila. Additionally, resources may have to do overtime and work on weekend’s basis business requirement."

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Lean Six Sigma, Six Sigma, Quality Assurance, Change Management, Management, Technology