Policy Administration Performance Quality Assurance Manager

Overview

Job purpose

Performance, Quality & Compliance

• Develop and maintain a comprehensive Policy Administration Quality Framework across all policy admin processes.
• Review and enhance policies, procedures, SOPs, and internal controls to ensure accuracy and regulatory alignment.
• Conduct regular quality audits across transactional, process, digital, and regulatory areas.
• Ensure compliance with all relevant regulatory requirements.
• Lead corrective actions, root-cause analysis, and risk remediation.
• Identify operational risks affecting accuracy, SLAs, TAT, or customer experience and implement mitigation measures.

Operational Governance

• Oversee end-to-end policy admin workflows and ensure proper process governance.
• Validate and approve process changes while assessing downstream impact.
• Conduct impact assessments for system changes, regulatory updates, and product amendments.
• Establish and monitor KPIs, dashboards, and quality performance metrics.
• Manage escalations related to complex or high-risk operational cases.

Systems & Technical Validation

• Lead validation of system enhancements, UAT cycles, regression testing, and automation initiatives.
• Work closely with IT, Digital and Product teams to ensure core systems and portals reflect accurate policy admin rules and benefit structures.
• Maintain integrity of master data, including products, benefits, setups, regulatory submissions.

Training & Change Management

• Assess capability gaps and define targeted training for policy admin teams.
• Deliver training on systems, processes, product rules, benefit mapping, quality standards, and regulatory requirements.
• Maintain a policy admin knowledge hub with SOPs, guides, and validation frameworks.
• Lead change management initiatives for product launches, regulatory changes, and system rollouts.

Stakeholder Collaboration

• Collaborate with Product, Underwriting, Sales, Customer Care, Provider Relations, Finance, IT, and Regulatory teams to ensure smooth end-to-end policy administration processes, resolve operational issues, and support accurate and compliant policy setup and servicing.
• Represent policy admin in governance forums, audits, regulatory inspections, and key decision meetings.
• Provide structured reporting, dashboards, and RCA insights to senior leadership.

Audit & Regulatory Readiness

• Lead and coordinate internal/external audits and regulatory inspections.
• Prepare audit documentation and ensure timely implementation of corrective actions.

Data, Analytics & Reporting

• Generate insights using quality dashboards, accuracy trends, TAT performance, and error analysis.
• Identify systemic issues and improvement opportunities through pattern and trend analysis.
• Produce monthly governance reports highlighting performance, risks, and action plans.

Operational & Technical Responsibilities

• Ensure adherence to internal controls and regulatory guidelines.
• Act as the senior escalation point for complex cases requiring technical judgment.
• Maintain and enhance operational guides, checklists, and validation tools.
• Support business continuity readiness during peak periods and major rollouts.

Education & Experience

• 5–7 years of experience in policy administration, operational quality, or health insurance operations.
• Strong experience in performance management, quality assurance, compliance, and end-to-end policy admin workflows.
• Experience in multi-system environments and involvement in system or process transformation initiatives.
• Certifications in Lean, Six Sigma, or Quality Management are an advantage.
• Experience working across varied regulatory environments is preferred.

Technical Skills

• Strong understanding of policy issuance, renewals, endorsements, benefit structures, membership updates, and validation controls.
• Good understanding of underwriting principles, benefit mapping, and data accuracy management.
• High proficiency in Excel, Power Query, dashboards, and data analysis tools.
• Strong analytical, auditing, and RCA capabilities.
• Excellent documentation skills (SOPs, validation sheets, process guidelines).

Leadership & Behavioural Skills

• Strong leadership and ability to influence across teams.
• High level of ownership, accountability, and attention to detail.
• Ability to work effectively in a fast-paced, high-volume environment.
• Excellent communication, presentation, and stakeholder management skills.