Our client, a dynamic & fast-growing Financial Services Company is looking for an experienced Medical Quality Assurance Team Leader with extensive exposure to claims. You will be leading and supporting a team of quality assessors.Role Purpose
- To guide the team in terms of their required output
- Setting clear team goals, and continuously monitor these
- To report to the QA Senior Manager on the month’s output and highlight trends
- Creating an inspiring team environment with an open communication culture
- To operate as a spokesperson for the team and interact with departments and related parties and stakeholders to relay matters relevant to quality assurance
- To provide analysis, definition and direction to the team of quality assessors
- To recommend training and/or coaching requirements based on outcomes of quality assurance audits of the quality assessors
- To manage the workflow of the department
- To ensure that the quality assessors’ output is of a high quality standard and of a consistent approach. Continuously engage Stakeholders and provide feedback on QA output, providing recommendations on improvement
- Delegating tasks and set deadlines for your internal team
- To provide input to the QA Senior Manager for month-end reporting to the Scheme and BU
Requirements:
- Matric/Grade 12 –Essential
- At least 2 years leadership/management experience – Essential
- Experience in QA and proven leadership capabilities with specific claims experience in the medical scheme / medical aid environment
- Exposure & experience in Membership & Claims within a medical scheme / medical aid environment
- Computer Literacy –; All Microsoft products, especially Excel and Word – Essential
- Experience in working with voice recording technologies – Advantageous
- Excellent communication and leadership skills
- Proven report Writing experience – Essential
- Sound knowledge of the Medical Aid industry
Responsibilities and work outputs:
- Audit the scores achieved from quality assessments
- Compare the scoring results amongst quality assessors for consistency
- Conduct regular calibrations to maintain QA consistency amongst the assessors
- Render support and facilitate sessions to quality assessors
- Audit the quality assessors’ reports on statistics provided as per their job description
- Participate in the recruitment of staff in accordance with the company’s’ Employment Equity targets
- Ensure that all staff have a PDP (Personal Development Plan)
- Identify on an ongoing basis the training needs of the staff under direct control
- Facilitate/support training requests where appropriate
- Identify training needs for direct reports, and staff in operational areas
- Track and monitor continuously, as to ensure that there is Staff development in the business
- Set up meetings and regularly meet with the QA Leadership Team and discuss status of the output, targets and objectives
- Take joint accountability with QA, and support to ensure that departmental objectives are met
- Drive the implementation and adherence of formal productivity and quality measurement standards within the team
- Manage the performance of staff within expected levels of their job description or agreed objectives
- Plan, control and undertake testing/quality assurance and implementation of the new and/or enhanced system or business process as approved
- Analyse facts to determine problems, risks, solutions and options
- Formulate strategies and guidelines to improve the business environment
- Facilitate the implementation of new/enhanced processes
- Ensure that coaching sessions by the quality assessors are regularly scheduled and effected
- Audit the completed coaching reports
- Ensure that follow up sessions and goals are being met as identified in coaching reports
- Ensure that all documents pertaining to feedbacks of Quality are maintained and stored
- Audit recording of telephone extensions as requested
- Sample audit and analyse lengthy and short calls
- Any other quality audits as required
- Train all new customer service agents on quality assurance processes where required –; Business Unit Specific
- Train all new quality assessors
- Draft modules for training m material
- Maintain training material
- Continuously stay abreast of developments in Momentum Metropolitan and Business Unit related to all areas of the business by accessing relevant information vehicles such as the Intranet and Internet, knowing how all interface with the business through participation in meeting forums
- Maintain computer literacy to generate clear and concise quality and statistical reports
- Keep abreast of Back Office Operations, QA and voice recording technology to ensure work methods and procedures are effectively managed
- Study subject related literature in order to stay abreast of developments and trends in the fields of expertise
- Sound knowledge of Medical scheme rules & benefits