Quality Assurance Analyst for us based healthcare insurance firm based in iloiloLegato Health Technologies, Phils., Inc.

Responsible for evaluating the quality of services and interactions provided by organizations within the enterprise. Included are processes related to enrollment and billing and claims processing, as well as customer service written and verbal inquiries.
 
Primary duties may include, but are not limited to:
Evaluates the quality and accuracy of transactions and/or communications with providers, groups, and/or policyholders.
Identifies, documents, and reports any transaction errors or communications issues in a timely manner to ensure prompt resolution.
Tracks and trends audit results, providing feedback to management. Identifies and reports on systemic issues which create ongoing quality concerns.
Generates monthly reports of audit findings, supports clients with issues identified and develops reports to assist management with information requested.
Produces other ad hoc reports as requested by internal and external clients.
Associates at this level conduct routine to complex audits, generally related to one or more functions on one or more systems platform for one or more lines of business.
Qualifications:
Requires a BA/BS degree
3 years of experience including a minimum of 1 year of related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background
Working knowledge of insurance industry and medical terminology, detailed knowledge of relevant systems and proven understanding of processing principles, techniques and guidelines; and ability to acquire and perform progressively more complex skills and tasks in a production environment required
Willing to work at Mandurriao, Iloilo City in night shift / shifting schedules
 
To expedite the process of your application, please have your government numbers / IDs ready (SSS, Tin, Philhealth, Pagibig) and NBI Clearance.  
 
About Legato PH
 
Legato Health Technologies Philippines is an Anthem company. Established in December 2018, Legato Philippines is an independent services provider to the Anthem companies with the purpose of leveraging global scale and executional expertise to transform health care management services as a GIC (Global In-house Center)
 
We are committed to transforming health care through operational excellence. We develop the technology, solutions and programs that give consumers greater access to care, while working with providers to ensure a quality health care experience for consumers.
 
Legato Health Technologies Philippines is a place for skilled and compassionate individuals, who share our goal to make a difference. We apply service excellence through handling inquiries and medical concerns. We provide Call Center, Clinical, and Applied Health IT services, led by our seasoned and visionary leadership team who is dedicated to outstanding customer service. Our work environment reflects the services we provide. We champion collaboration and innovation to drive our employees to deliver the best care.

2 to 4 Years Experience