Qa jobs in United States

Role Purpose: This role offers exciting and challenging opportunities for a dynamic, performance-oriented, knowledgeable, and experienced individual. The candidate must deliver quality outputs in a fast-paced, high-volume client-oriented environment, excelling both independently and as part of a team. This position is essential for maintaining and improving the quality standards across the organisation, ensuring exceptional client service and operational efficiency.

• Valid Matric Certificate
• Proven process specialisation with a medical scheme administration
• Experience in quality assessment within a medical scheme administration business
• Subject management experience relative to allocated stakeholder areas and proven proficiency at an advanced level
• Strong performance orientation
• Knowledge of the scheme''s rules and benefits
• Competence in generating quality and statistical reports
• Familiarity with all operational processes employed within the administration business
• Proven specialisation in delegated process focus areas

• Ability to remain impartial
• High focus on customer expectations and experience
• Ability to maintain cooperative working relationships
• Ability to work independently and as part of a team
• Ability to give constructive feedback and coach
• Analytical and problem-solving skills with the ability to make decisions
• Ability to communicate recommendations in a constructive manner
• Excellent interpersonal and communication skills (written and verbal)
• Strong client service and relationship management skills

• More than 2 years proven experience within designated process focus area within a medical scheme administration business
• Proven specialisation courses within designated process focus area within a medical scheme administration business
• Proven exceptional quality scores/outcomes in experience process areas

• Internal Process
  • Conduct daily quality checks for all operational areas as directed by the scheme, including: correspondence management; call- and walk-in centre operations; enquiry management; claims processing; ex-gratia; membership services; underwriting; customer experience
  • Weekly quality checks and revision of cases shared by the technical department with updates on the QA database
  • Coaching: notify employees assessed of QA outcomes; schedule and conduct coaching sessions
  • Record keeping: maintain valid, accurate, and up-to-date records of employees assessed
  • Issue notifications and promptly inform team coaches of QA issues
  • Ensure timely investigations and task completion from QA findings
  • Attend stakeholder meetings and share QA learnings; ensure timely completion of investigations
  • Engage regularly with assessed employees and leaders
• Continuous Development
  • Stay informed about developments within Metropolitan Health, particularly People, Process and System changes
  • Communicate changes with QA leaders to ensure alignment of QA training and QA processes
• Knowledge Enhancement
  • Understand the scheme''s Rules and Benefits; attend annual updates
  • Maintain up-to-date knowledge for allocated areas to be a subject matter expert
  • Proactively drive enhancements
• Quality Statistics Reporting
  • Capture quality outcomes for all assessments to enable detailed reporting and insights for stakeholders
• Client
  • Build and maintain relationships with designated stakeholder groups (clients & internal stakeholders)
  • Deliver on service level agreements to manage client expectations
  • Make recommendations to improve client service and fair treatment within the area of responsibility
  • Contribute to a culture of rewarding relationships, feedback, and exceptional client service
  • Monitor turnaround times and quality standards; resolve issues swiftly
  • Manage client query processes, track queries, resolve them, and use insights to improve service
• People
  • Build strong relationships by providing specialist know-how and leadership
  • Continuously develop own expertise and apply it in specialisation
  • Influence and manage change; provide specialist support as required
  • Contribute to continuous innovation and a culture of quality management
  • Take ownership of driving career development
• Finance
  • Contribute to area budgets to minimise expenditure and improve efficiency
  • Identify solutions to enhance cost-effectiveness
  • Provide input into governance processes and escalate unresolved issues
• Note: Provide input into risk identification processes and communicate recommendations to ensure QA framework alignment.

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