Team Lead
Hyderabad, Telangana, India
2d ago

Qualification :

Graduate / Post Graduate preferably MBA graduates Knowledge of CRM tools & MS office tools

  • For Medical Management and Provider Services Bachelor’s Degree in Nursing (BSN).
  • For Philippines 34 year college degree preferably related to medical field (as mandated by the project).
  • For NA High School / Equiv, Associates Degree preferred or equiv work experience.
  • Responsibility :

    Business / Customer :

  • Certify controls laid down by the business to ensure successful audit by client and external party.
  • Interact with customers (internal / external) and keep stakeholders appraised of the process performance.
  • Create status reports for customers (internal / external).
  • Manage and resolve escalations and issues raised by customers and process specialists.
  • Ensure adherence to Quality norms and procedures.
  • Identify & drive opportunities not limited to Cost Optimization and Process Excellence to enhance service delivery.
  • Provide client / process related MI reports.
  • Interface with the management both in terms of cascading messages from senior management and putting into practice strategy or modifications required for the process based on decisions taken.
  • Identify & drive opportunities to enhance customer experience.
  • Anticipate issues and needs of the customer related to the project and address them proactively.
  • thereby help achieve CSS targets.
  • For Claims, Medical Management & Provider Services :

  • Communicate with the client counterpart on a daytoday basis on daily scorecards.
  • For NA TM :

  • Participate in Customer review / governance meetings to discuss on Service performance, project issues and improvement opportunities.
  • Anticipate issues and needs of the customer related to the project and address them proactively.
  • thereby help achieve CSS targets.
  • Project / Process :

    For Medical Management, RCM and Provider Services :

  • Ensure timely completion of tasks assigned to all team members.
  • Develop SOPs and training Manuals.
  • Generate periodic performance reports and dash boards for the process.
  • Capture relevant metrics periodically.
  • Communicate resource issues to Operation Manager.
  • Inform the teams of any process updates and document the same.
  • Review and update domain specifics.
  • For Provider Services :

  • Communicate SLA to enabler functions based on timeframes.
  • Actively participate in discussions with the Quality / PEX teams to identity process improvements.
  • Lease with NSS to ensure Telecom connectivity & Proper Working of workstation as per specification.
  • Lease with Admin for Transportation & all other admin related work.
  • Lease with HR for on time & quality recruitment.
  • Track Project Performance Quality & Quantitative Metrics.
  • Ensure adherence to Quality norms and processes.
  • Adhere to security practices set by organization.
  • Maintain confidentiality of all information, policies, and procedures as required by the Health Insurance Portability and Accountability Act (HIPAA) protocols.
  • For Medical Management and RCM :

  • Oversee daily operations, processes to ensure that all quality and efficiency standards and targets are met.
  • including but is not limited to daily completion rate, accuracy of data encoded in the review, attendance and adherence to company protocols.
  • Oversee the performance of new on boards and ensures coaching of the team.
  • Analyze areas for improvement for meeting program objectives and participates in establishing Quality Improvement Projects for the program.
  • Provide weekly coaching to the team in relation to their scope of work.
  • Cascade essential information and updates to team through the weekly meetings.
  • Provide regular and periodic feedback to the Program Manager on the team performance for coaching and appraisal purposes.
  • Ensure that immediate supervisors are appraised on significant program activities, issues and concerns through emails, meetings and weekly reports.
  • Handle staff questions and escalation as necessary.
  • Perform senior process executive functions as needed.
  • Supervise the hiring process.
  • Review all QC and QA reports and reinforce corrections and suggestions made the quality reviews team.
  • Collaborate with the team and clients and assists the Operations manager with managerial activities as needed.
  • Reward and discipline employees.
  • address complaints and resolve problems.
  • Coach and develop Nurse Reviewers, Administrative Staff, Subject Matter Experts (SME), and Team Lead to promote an understanding of the company culture, policies, goals and procedures.
  • For Claims, NA, RCM and Member Services :

  • Support Knowledge transfer at the time of process transition from the business site.
  • Drive team to achieve process Service Level Agreements / metrics ie productivity and quality targets within the established timelines.
  • Ensure compliance controls are met.
  • Ensure documented process guidelines are followed.
  • conduct periodical reviews for process adherence.
  • Conduct adhoc Quality checks.
  • Review process audit findings and take corrective action.
  • Innovate ideas to error proof the process & reduce manual interventions.
  • Conduct process training or refresher trainings, if required.
  • Maintain operations rigor around daily huddles, visual management, knowledge management, cross training etc.
  • Initiate and deliver on process improvement projects to improve process efficiencies.
  • Provide updates and submit reports related to own area of work.
  • Ensure optimum resource utilization through cross training initiatives and buffer management.
  • Interface with other departments for getting required assistance or support for the team.
  • Engage with other processes to understand and implement best practices.
  • Lead calibration initiatives with the client and for the team.
  • Drive a culture of continuous improvement within the team.
  • For NA :

  • Provide updates and submit reports related to own area of work.
  • Is the escalation contact for clients and internal stakeholders.
  • Ensure all data update requests are tracked and status updates provided to management.
  • Plan resource rotation to comply with Organization / Business Unit recommended Pyramid and Span.
  • Manages project risks and issues, ensuring that project team members are actively involved in the identification and where appropriate the ownership of risks, initiating corrective action where necessary.
  • For NA TM Only :

  • Follows customer profitability practices such as Cost optimization methods, productivity & quality benchmarking, periodic target revision etc.
  • Ensure tracking and collating of Quality (internal, external & client facing) data is performed accurately through BPS Quality Report.
  • Participate and provide inputs during Solution development activities Build relationships with line managers or portfolio owners in the customer organization.
  • Share best practices with the Organization and leverage Organization assets for the benefit of the project.
  • Establishes the key calendar of events for the project / LOB.
  • Identify and highlight areas of risk in the process.
  • People / Team :

  • Ensure appropriate distribution of work among direct reports.
  • Responsible for creation and implementation of learning plans and skill upgrade.
  • Responsible for Performance management and career development of the team members.
  • Encourage Team to contribute and participate in training programs.
  • For Medical Management, RCM and Provider Services :

  • Ensure completion of training plan for all direct reports.
  • Responsible for driving Reward & Recognition and employee engagement.
  • For NA, Claims, RCM, Provider Services and Member Services :

  • Guide and mentor team members.
  • Groom self and team to support vertical / business growth.
  • Conduct team building activities to enhance motivation.
  • Conduct regular 101s to gauge the pulse of the team members.
  • Complete mandatory training for self as identified in the training plan for the project.
  • Review VOC scores, provides feedback and recommend refresher training whenever necessary.
  • Report to the manager on per.
  • Good To Have Skills

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