Healthcare Quality Analyst - Healthcare BPO

Access Healthcare Services Manila, Inc.; Pasay; On-site; PHP 350,000 - 550,000; Full time

Job summary

Access Healthcare Services Manila, Inc. is seeking a detail-oriented Healthcare Quality Analyst to join our BPO team in Metro Manila. The role focuses on monitoring healthcare processes, ensuring accuracy, compliance with HIPAA, and delivering client expectations.

You will analyze metrics, collaborate with operations, develop scorecards, and coach agents to improve quality. Strong knowledge of healthcare claims, billing, and regulatory standards is required.

Qualifications

• Prior experience in healthcare BPO, quality assurance, or auditing roles.
• Strong knowledge of healthcare processes (claims, billing, utilization review, medical coding).
• Familiarity with HIPAA and other healthcare compliance regulations.
• Excellent analytical, communication, and problem-solving skills.
• Proficiency in MS Office tools and quality monitoring systems.

Responsibilities

• Quality Monitoring & Evaluation: Review and audit healthcare transactions, claims, and customer interactions for accuracy and compliance.
• Identify gaps in process execution and recommend corrective actions.
• Ensure adherence to HIPAA, data privacy, and other healthcare regulations.
• Analyze performance metrics and trends to identify efficiency and quality improvements.
• Collaborate with operations teams to implement best practices and process changes.
• Develop and maintain quality scorecards, reports, and dashboards.
• Provide feedback and coaching to agents based on audit findings.
• Assist in designing training modules focused on compliance and accuracy.
• Support new process transitions by validating quality standards.
• Maintain accurate records of audits, findings, and corrective actions.
• Participate in internal and external audits as required.

Skills

Analytical thinking

Attention to detail

Communication skills

Problem-solving

Tools

MS Office

Quality monitoring systems

Job description

We are seeking a detail-oriented and analytical Healthcare Quality Analyst to join our Business Process Outsourcing (BPO) team. The role is critical in ensuring that healthcare-related processes meet compliance standards, deliver exceptional service quality, and align with client expectations. The ideal candidate will have strong knowledge of healthcare operations, quality assurance methodologies, and regulatory requirements.

Key Responsibilities

• Quality Monitoring & Evaluation

  • Review and audit healthcare transactions, claims, and customer interactions for accuracy and compliance.

  • Identify gaps in process execution and recommend corrective actions.

  • Ensure adherence to HIPAA, data privacy, and other healthcare regulations.

• Process Improvement

  • Analyze performance metrics and trends to identify opportunities for efficiency and quality enhancement.

  • Collaborate with operations teams to implement best practices and process improvements.

  • Develop and maintain quality scorecards, reports, and dashboards.

• Training & Support

  • Provide feedback and coaching to agents and teams based on audit findings.

  • Assist in designing training modules focused on compliance, accuracy, and customer service.

  • Support new process transitions by validating quality standards.

• Compliance & Documentation

  • Maintain accurate records of audits, findings, and corrective actions.

  • Ensure compliance with client-specific guidelines and industry standards.

  • Participate in internal and external audits as required.

Qualifications

• Prior experience in healthcare BPO, quality assurance, or auditing roles.

• Strong knowledge of healthcare processes (claims, billing, utilization review, medical coding).

• Familiarity with HIPAA and other healthcare compliance regulations.

• Excellent analytical, communication, and problem-solving skills.

• Proficiency in MS Office tools and quality monitoring systems.