Job
Description
As a Claims Quality Auditor, your role involves reviewing claims transactions and providing feedback to claims processors in order to improve process efficiency and quality. By analyzing and designing workflows and business processes, you will contribute to enhancing existing processes and implementing new ones. Key Responsibilities: - Review various documents such as medical documents, policy documents, claims history, and system notes to ensure claims processors adhere to client-specific business rules. - Develop and maintain a comprehensive understanding of the insurance industry, products, services, and processes related to Claims function. - Conduct functional analysis of current business processes and supporting documentation. - Identify opportunities for process improvements and lead the reengineering of business processes. - Create process and value stream maps for both existing and new business processes. - Assist in establishing and documenting standard operating procedures and knowledge transfer documentation. - Collaborate effectively with team members to achieve customer goals. Key Metrics: - Audit Productivity - Accuracy - Feedback - Percentage of automation or mistake-proofing implemented Qualification: - Bachelors degree Experience: - Minimum of 3 years' experience as a Transactional Quality Auditor/MIS specialist/Quality associate with a focus on implementing quality framework elements. - Experience in Life Insurance Claims and Policy Administration Minimum Skills: - Proficiency in claims business process redesign, gap analysis, functional vs technical specifications, and change management. - Strong data collation and report generation skills with a high level of accuracy. - Excellent communication abilities to convey business requirements effectively to technical and development teams. - Familiarity with process mapping tools such as MS Visio, Lucid Charts, Excel, and PowerPoint. - Knowledge of Lean Six Sigma methodologies. - Experience working in an Agile environment. - Familiarity with Salesforce or other modern case management systems. Please note the specific work hours for this role are from 5:30 pm to 3:30 am IST (Mon Fri) at NttData Office in Chennai or Coimbatore. As a Claims Quality Auditor, your role involves reviewing claims transactions and providing feedback to claims processors in order to improve process efficiency and quality. By analyzing and designing workflows and business processes, you will contribute to enhancing existing processes and implementing new ones. Key Responsibilities: - Review various documents such as medical documents, policy documents, claims history, and system notes to ensure claims processors adhere to client-specific business rules. - Develop and maintain a comprehensive understanding of the insurance industry, products, services, and processes related to Claims function. - Conduct functional analysis of current business processes and supporting documentation. - Identify opportunities for process improvements and lead the reengineering of business processes. - Create process and value stream maps for both existing and new business processes. - Assist in establishing and documenting standard operating procedures and knowledge transfer documentation. - Collaborate effectively with team members to achieve customer goals. Key Metrics: - Audit Productivity - Accuracy - Feedback - Percentage of automation or mistake-proofing implemented Qualification: - Bachelors degree Experience: - Minimum of 3 years' experience as a Transactional Quality Auditor/MIS specialist/Quality associate with a focus on implementing quality framework elements. - Experience in Life Insurance Claims and Policy Administration Minimum Skills: - Proficiency in claims business process redesign, gap analysis, functional vs technical specifications, and change management. - Strong data collation and report generation skills with a high level of accuracy. - Excellent communication abilities to convey business requirements effectively to technical and development teams. - Familiarity with process mapping tools such as MS Visio, Lucid Charts, Excel, and PowerPoint. - Knowledge of Lean Six Sigma methodologies. - Experience working in an Agile environment. - Familiarity with Salesforce or other modern case management systems. Please note the specific work hours for this role are from 5:30 pm to 3:30 am IST (Mon Fri) at NttData Office in Chennai or Coimbatore.
