Job Title:

Sr. Quality Evaluator

Job Description

Conduct audits of transactions, calls, or case handling to ensure process compliance and accuracy.
Identify errors and improvement areas in documentation, communication, or execution.
Provide feedback and coaching to team members based on audit findings.
Maintain quality records and generate periodic reports (daily/weekly/monthly).
Analyze trends in quality scores and suggest corrective actions.
Ensure compliance with client-specific and regulatory standards (e.g., HIPAA in healthcare).
Participate in calibration sessions to align quality standards across teams and clients.
Support training initiatives by sharing audit insights and helping develop SOPs and checklists.
Collaborate with stakeholders to drive continuous improvement in quality metrics.
Stay updated on process changes, tools, and client expectations to ensure audit relevance.

Attention to detail – To accurately identify errors in authorization requests and documentation.
Healthcare terminology knowledge – Familiarity with terms related to diagnoses, procedures, and medications.
Understanding of prior authorization workflows – Including verification, submission, follow-up, and closure.
Knowledge of payer-specific guidelines – Ability to interpret and apply insurance requirements correctly.
Analytical thinking – To assess audit findings and recommend process improvements.
Effective communication skills – For delivering clear feedback and collaborating with teams.
Proficiency in documentation – Maintaining thorough and accurate audit logs and reports.
System navigation skills – Comfort with healthcare platforms, CRMs, and QA tools.
Compliance awareness – Understanding of HIPAA and other regulatory standards.
Time management – Ability to handle multiple audits and meet deadlines efficiently.

Location:

IND Gurgaon - Bld 14 IT SEZ Unit 1, 5th, 6th and 17th Flr

Language Requirements:

Time Type:

Full time