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Manager - Quality Excellence

exl Service.com (India) Private Limited
Kochi, IND
Full-time
Manager · 5–7 years experience
Discovered Today
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Qualifications

  • 5–7 years of experience in Quality / Process Excellence, preferably in US Healthcare payer processes (claims, Medicare, appeals, prior auth or UM)
  • Lean Six Sigma Green or Black Belt certification from a reputed organization
  • Strong grasp of sampling, calibration, RCA and quality metrics
  • Experience leading QE teams and working with Ops and client stakeholders
  • Facets or similar claims platform exposure is an advantage
  • Strong Excel, dashboard and reporting skills; Power BI is a plus
  • Clear communication, comfortable presenting to leadership and clients
  • Primary skills (must-have)
  • Quality Management / Quality Assurance
  • US Healthcare – Payer
  • Claims Adjudication
  • Medicare / Medicare Advantage
  • Lean Six Sigma (Green Belt / Black Belt)
  • Root Cause Analysis (RCA)
  • Audit Sampling and Calibration
  • Process Improvement
  • Team Management
  • Stakeholder Management
  • Secondary skills (good to have)
  • Facets
  • Appeals and Grievances
  • Prior Authorization / Utilization Management
  • Transition Management
  • SOP Development
  • Power BI / Advanced Excel
  • P4P / SLA Management
  • Client Governance and Reporting

Responsibilities

  • Manage the QE team (AMs and QCAs), covering certification, monitoring, feedback and productivity
  • Drive governance through daily, weekly and monthly quality reporting, RCA and action plans, and client quality reviews
  • Partner with Operations to improve accuracy, reduce errors and meet client SLAs and P4P metrics
  • Support the transition by validating SOPs, building quality checkpoints and running UAT, dry runs and go-live readiness
  • Lead process improvement and standardization projects using Lean Six Sigma tools
  • Support internal and client audits, interactions and contribute to RFP/RFI responses when needed
  • Mentor and develop team members

Preferred Qualifications

  • Strong Excel, dashboard and reporting skills; Power BI is a plus

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