Join us as we work to create a thriving ecosystem that delivers accessible, high-quality, and sustainable healthcare for all.
Role summary
Drive measurable quality and operational improvements across Authorization Management by supporting and leading project execution, audit oversight, issue resolution, and process improvement initiatives as an Quality Associate in Chennai, India. You will apply strong healthcare operations and analytical expertise to improve workflow quality, identify root causes, and support cross-functional initiatives that strengthen authorization management performance. You will report to the Manager, Authorization Management Quality.
Team summary
The Authorization Management Quality team supports agents and operations colleagues who handle pre-certifications and referral work for providers. The team is accountable for quality oversight, audit support, issue resolution, project coordination, and continuous process improvement. You will contribute by using operational analysis, project leadership, and workflow knowledge to improve service delivery, strengthen accountability, and support scalable authorization management operations.
Essential Job Responsibilities
- Analyze authorization management quality data to identify trends, recurring issues, and opportunities for improvement.
- Lead or support complex projects and initiatives tied to team goals, quality outcomes, and workflow optimization.
- Own audit-related workflows for complex cases, ensuring timely, accurate, and consistent completion.
- Review task notes, audit histories, and supporting documentation to determine appropriate next steps and corrective actions.
- Coordinate with internal stakeholders to resolve issues, reduce delays, and minimize rework across authorization-related workflows.
- Document case notes, actions taken, and outcomes in required systems to maintain traceability and audit readiness.
- Validate quality by ensuring work aligns to SOPs, operational standards, and established acceptance criteria.
- Identify root causes for recurring quality themes and propose practical process improvements.
- Report on key operational metrics, audit findings, and escalation themes to support goal tracking and performance management.
- Use AI-enabled assistance to improve speed and consistency by leveraging AI-supported summarization and anomaly detection where available, while applying judgment to verify accuracy and follow SOPs.
Additional Job Responsibilities
- Support training and knowledge sharing by coaching peers on audit handling approaches, project execution, and quality expectations.
- Contribute to process documentation updates and job aids based on observed operational learnings.
- Participate in quality calibration sessions to align on audit interpretation, documentation requirements, and escalation thresholds.
- Assist with implementation planning for process changes that affect authorization management workflows.
- Engage in continuous improvement projects aimed at improving accuracy, reducing cycle time, and supporting more efficient workflows.
- Participate in special investigations or deep dives for escalated quality or issue-tracking cases.
- Coordinate meetings, working groups, testing, product discussions, and process research as needed.
- Identify opportunities to reduce inflow through automation or process improvement.
- Serve as a mentor and escalation point for team members when required.
- Help create and update documents for projects and processes relevant to the team.
Expected Education & Experience
- Bachelor's degree required graduation in Nursing, Dentistry, Physiotherapy, or any health science preferred.
- 5-8 years of relevant professional experiencein the healthcare industry.
- Demonstrated experience handling projects, driving outcomes, and working with higher levels of operational complexity.
- Experience in quality, audit, operations, or related analytical operational roles preferred.
- Proficiency in Microsoft Office Suite.
- Strong understanding of SOPs and quality standards to achieve consistent outcomes.
- Ability to analyze trends and translate findings into recommendations for process improvements.
- Strong communication skills to escalate, coordinate, and explain findings clearly to stakeholders.
- Ability to work effectively in a fast-paced, cross-functional, hybrid environment based in Chennai, India.
