Healthcare Quality Auditor | Remote

Role: Healthcare Quality Auditor | Remote

“Join our team and make a real difference in the healthcare experience! This is not just a job; it's an opportunity to be a leader and a changemaker.”

Position Summary:

Imagenet Phils is seeking a dedicated and results-oriented Healthcare Quality Auditor with a strong background in US Healthcare Insurance to join our growing team. A crucial role in ensuring the delivery of high-quality customer service by auditing and evaluating customer interactions. This role focuses on daily call listening and auditing to uphold company standards and compliance.

The ideal candidate will have extensive experience in utilization management review (UMR), enrollment management, claims processing, and billing.

This is an Urgent Hiring. We will process only qualified applicants.

Key Responsibilities:

• Call Evaluation: Listen to and assess recorded customer service calls to ensure compliance with company policies and quality standards.
• Regulatory Compliance: Ensure all interactions adhere to regulatory requirements and internal guidelines.
• Feedback Provision: Deliver detailed feedback to agents and supervisors based on audit findings. Generate and present audit reports to management.
• Training Support: Identify training needs from audit results and collaborate with the training team to address these needs.
• Continuous Improvement: Recommend and assist in creation of process improvements and best practices to enhance service quality and customer satisfaction.
• Documentation and Note-Taking: Maintain detailed records of audit findings, including specific examples and notes on areas for improvement. Ensure all documentation is accurate, organized, and easily accessible for future reference.
• Performs additional duties as requested by management.
  

Qualifications:

• Education: Bachelor's degree in business, Communications, or related field preferred.
• Experience: 
  • Minimum of 3 years in a quality assurance role in a US Healthcare campaign in a BPO environment (preferably Voice accounts)
    
  • Strong understanding of customer service KPIs, quality metrics, and performance evaluation.
• Skills:
  • Knowledgeable in RCM, UMR, enrollment management, claims processing, and billing.
  • Strong analytical and listening skills.
  • High attention to detail.
  • Excellent communication and interpersonal skills.
  • Ability to provide constructive and actionable feedback.
  • Proficiency in call monitoring software and tools.
  • Conflict Resolution: Ability to handle and resolve conflicts effectively.
  • Adaptability: Flexibility to adapt to changing processes and environments.
  • Empathy: Understanding and addressing the needs and concerns of agents and customers.
  • Independence: Ability to work independently with minimal supervision.

Requirements:

• US Healthcare industry experience required.

• Knowledgeable in MS Office applications especially Word, PowerPoint and Excel

• Strong team player with a high level of professionalism and initiative

• Must reside within NCR or neighboring region for contingency.

• Willing to work onsite in Makati

• Can start ASAP

Additional Benefits:

• HMO (Medical and Dental) Coverage Day1 w/ 1 Free Dependent
• 13th Month Pay
• Internet Allowance
• Equipment is provided

**Work Arrangement: This position is currently offered on a REMOTE work basis after successful completion of training. However, please note that this is a performance-based role, and the company reserves the right to require employees to report onsite at any time based on business needs, performance evaluations, operational requirements. Flexibility to transition to an office-based setup when necessary is expected.

***WORK FROM HOME REQUIREMENTS***

•  High Speed Internet of 25MBPS download and 5MBPS upload. You will be required to provide a speed test.
• Ability to directly hardwire to your modem
• Required to have a quiet dedicated work area.

COMPANY OVERVIEW:

Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans’ members and providers.

The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans’ members and providers. The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually. The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients.

Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.