Call Quality Specialist - Optum Health Behavioral Solutions - Hyderabad
- Optum
- 2 - 5 Years
- Hyderabad
- 3 years ago
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Job Description
Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)
Primary Responsibilities:
- Performs routine or structured work
- Responds to routine or standard requests
- Uses existing procedures and facts to solve routine problems or conduct routine analysis
- Probe on relevant process concerns in order to obtain relevant information for audits
- Listen to calls and validate information like member data, provider data against information from claims processing or business processing systems to ensure that data / decisions / payment and recovery / settlement information. etc. is accurate
- Analyzes the call conversation against applicable policies and regulations to identify potential issues (e.g., member benefits, provider contracts, billing anomalies, payment accuracy, claims processing system issues, state mandates)
- Reviews history of related accounts discussed on the calls to pull in and understand additional related information
- Maintains reporting infrastructure, as appropriate (e.g., SharePoint, Access databases)
- Develops and delivers fact - based audit determinations in an objective, non - confrontational manner
- Escalates issues identified during the audit cycle or rebuttal process to applicable stakeholders, as appropriate (e.g., Subject Matter Experts, Operations Team, Quality Team, business partners, team leads)
- Ensures compliance with applicable audit and rebuttal timelines (e.g., calibration timelines, rebuttal timelines / form completion, workflows, turnaround time)
- Achieves production quality goals / metrics (e.g., audits per hour, audit accuracy, rebuttal accuracy)
- Provides supporting documentation for audit findings
- Manages audit inventory to ensure proper workload balance, coverage and closure
- Identify / communicates escalated errors / defects and ensure proper resolution, as needed (e.g., calibrations, rebuttals, appeals)
- Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
- Graduate
- 2+ years prior experience in voice operations with call quality in-depth knowledge
- Microsoft Office skills including Microsoft Word (create / edit), Microsoft Excel (data entry, sort / filter, edit), and ability to understand basic excel data structure
- High level knowledge of quality process / approach
- Basic knowledge of theories, practices and procedures related to recovery and resilience call quality
- Very good written and verbal communication skills and fluency in English
Preferred Qualification:
- 1+ years of experience within a matrix organization, healthcare, or insurance company
Soft Skills:
- Interpersonal Skills - ability to deal and work with people with different backgrounds.
- Prior knowledge / experience with account-based products. Decision - Making Skills - capable of arriving at the appropriate decisions after weighing the pros and cons of all the options in consultation with department managers / SMEs
- Excellent verbal and written communication skills in addition be a good listener to give value to the opinion and suggestion of others
- Accountability - Takes ownership of tasks, performance standard and quality results. Maintains necessary attention to detail to achieve high level performance
- Problem Solving - Solution Driven Approach Skills - demonstrate ability to review problem, troubleshoot root cause issues and determine path to resolution with appropriate guidance.
- Flexible - Able to work effectively in a changing environment and contribute innovative ideas
- Accuracy and Efficiency - Excellent time management and organizational skills balancing multiple priorities. Accurate when processing detailed tasks while meeting deadlines
- Self-starter, able to independently, drive work and prioritize work with moderate oversight
Employement Category:
Employement Type: Full timeIndustry: Hotels
Functional Area: Customer Service
Role Category: Software Engineer
Role/Responsibilies: Call Quality Specialist - Optum Health Behavioral Solutions - Hyderabad
Contact Details:
Company: OptumLocation(s): Hyderabad
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Optum
About: OptumInsight India Pvt Ltd, a UnitedHealth group company is a leading health services and innovation company dedicated to help make the health system work better for everyone. With more than 115,000 people worldwide, Optum combines technology, data and expertise to improve the delivery, ...
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