Job Overview
We are looking for a highly competent, result-oriented medical professional with focus on quality improvement within the call center.
The QA officer will ensure that customer service and interactions meet the company’s standards for quality, accuracy and customer satisfaction by identifying areas of improvement and working with different teams to ensure cost-efficiency throughout the process.
Key Responsibilities:
- Monitor customer interactions
- Review calls, emails, chat logs and any other customer interaction channel to assess quality and accuracy of the information
- Ensure that the call center agents follow and adhere to call scripts, handle calls within acceptable matrix, maintaining professionalism and resolving issues efficiently.
- Ensure that agents use correct systems, tools and processes to handle customer enquiries.
- Evaluate Outpatient requests adherence to standards
- Review outpatient requests to identify any emerging trends and issues
- Identify areas of concern from a cost and quality perspective to enable address them with the medical service providers.
- Identify issues and exposure that require to be addressed from a policy perspective, liaising with underwriters by making recommendations.
- Monitor and review outpatient turnaround times to ensure efficiency.
- Outpatient approvals
- Identify and drive cost saving initiatives
- Monitor accuracy of approvals and declines and the process associated with each.
- Ensure accuracy in approvals and declines and how these are communicated to providers and customers.
- Standardize outpatient approvals across clinical teams to ensure consistency.
- Provide feedback and coaching
- Deliver feedback with agents on their performance highlighting areas of strengths and identifying areas of improvement.
- Identify gaps and opportunities, providing recommendations for Continuing Medical Education (CME).
- Track and report key matric e.g. NPS, NES and FCR
- Share insights with management to help drive process, product and system improvement.
- Documentation and reporting
- Documentation of all quality assurance and control activities
- Review and approve quality related documentation such as SOPs
- Prepare quality performance reports to senior management, highlighting key quality metrics, audit findings, and improvement initiatives.
- Support continuous improvement
- Proactively suggest process or procedural improvements based on customer feedback and observed performance and industry trends.
- Promote a culture of continuous improvement within the team
Educational Qualifications
Bachelor’s degree in clinical medicine, Nursing, or Health Systems Management.
Registered and certified by the relevant professional council (e.g., Nursing Council, Clinical Officer Council).
Professional Certifications in quality management is an added advantage.
Skills And Experience
- Minimum of 3 years of experience in Quality Assurance in a health insurance environment.
- Attention to details
- Excellent verbal and written communication skills
- Analytical thinking
- Problem solving
- Team collaboration.
This role is responsible for quality assessment on calls made and accounts worked within the Collections Call Centre environment and is individually accountable for achieving results through own efforts.
Responsibilities
Quality Assurance Testing
Select the appropriate complex tests or tests from a specified range and carry out using specialized methods and equipment; validate and interpret test data to verify that specifications are met and/or to identify remedial actions required to ensure conformance or suitability.
Quality Assurance Testing Design
Validate new or existing complex test methods and procedures; identify issues and recommend improvements to contribute to further development.
Quality Management System
Contribute to the identification and evaluation of current policies and business processes that are in the scope of the quality management system (QMS); contribute to the design of the QMS; provide specialist quality management input to the drafting of new policies and procedures and the design of business processes; contribute to the quantification of the costs and business benefits of change.
Health, Safety, and Environment
Follow the organization’s health, safety, and environment (HSE) policies, procedures, and mandatory instructions to identify and mitigate environmental risks and risks to the well-being of self and others in the workplace; instruct the team in safe working methods; identify instances of risky behaviors within the team and take appropriate action, escalating serious issues as appropriate.
Improvement/Innovation
Identify shortcomings in existing processes, systems, and procedures, and use established change management programs to address them.
Operational Compliance
Identify, within the team, instances of noncompliance with the organization’s policies and procedures and/or relevant regulatory codes and codes of conduct, reporting these instances and escalating issues as appropriate.
Leadership and Direction
Explain the local action plan, to support team members in their understanding of what needs to be done, and how this relates to the broader business plan and the organization’s strategy, mission, and vision; motivate people to achieve local business goals.
Stakeholder Engagement
Assist with stakeholder engagement by arranging actions, meetings, events, and supporting materials to promote stakeholder understanding and commitment.
Data Collection and Analysis
Collate and analyze data using preset tools, methods, and formats. Involves working independently.
Performance Management
Respond to personal objectives and use performance management systems to improve personal performance; or monitor the performance of the team, allocate work and review completion, take appropriate corrective action to ensure timeliness and quality, and contribute to formal individual performance management and appraisal.
Organizational Capability Building
Provide coaching to team members to develop their skills.
Skills
Action Planning, Change Management, Data Analysis, Data Compilation, Evaluating Information, Executing Plans, Legal Practices, Policies & Procedures, Presenting Solutions, QA Methodologies, Regulatory Compliance Management, Report Review
Competencies
Communicates Effectively
Courage
Directs Work
Ensures Accountability
Instills Trust
Manages Complexity
Optimizes Work Processes
Tech Savvy
Education
Bachelor of Science in Nursing (BScN)
Closing Date
17 April 2025 , 23:59
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