We are looking for a manager – Quality Excellence to set up and lead the quality function for a US Healthcare Client in Kochi. The role will own the quality methodology from transition through steady state, working closely with Operations, Training and client stakeholders.
Expertise in Claims Adjudication, Appeals Review, Contact Center preferred
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
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
Transition Management
SOP Development
Power BI / Advanced Excel
P4P / SLA Management
Client Governance and Reporting
Job description provided by EXL Service.
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