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  • Posted: Feb 14, 2020
    Deadline: Feb 18, 2020
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  • We’re a health insurance company that acts like a technology company. We’re using software, data science and telemedicine to make health insurance more affordable, easier to access and more of a delightful experience
    Read more about this company

    Quality Assurance and Case Manager

    Expected Start Date: Q1, 2020

    The Position

    • The ideal candidate will work with our Provider Relations, Customer Success, Claims and Underwriting teams and make sure that excellent and high quality service is provided to our clients across all provider networks while ensuring resolution of complicated claims and limiting fraud
    • You will have major responsibility for managing the relationship between the company, our providers, and our enrollees. You will facilitate the delivery of prompt services for clients as required on a case by case basis and maintain a healthy cost-quality balance as far as patient care is concerned
    • You will track waste, fraud, and/or error from initial point of access to care by enrollees to final claims filing by the Provider

    You’ll love this opportunity because…

    • ...you'll have a clear career path
    • ...you'll have a lot of independence in managing projects
    • …we have a vibrant and active culture
    • …co-workers are a close-knit, intelligent, and motivated team

    Key Responsibilities

    • Work with the Provider Team to ensure the minimum standards for quality are met before sign up.
    • Inspect and evaluate hospitals to ensure compliance with basic standards.
    • Carry out physical inspection at the assigned provider’s office using the checklist.
    • Investigate complicated claims by checking the case folder and speaking to the Enrollee and the doctor.
    • Escalate fraudulent cases to the Committee of Doctors.
    • Update Providers’ dashboard, and implement resolutions.
    • Recommend changes to improve the efficiencies in the systems and process of the Provider Relations as well as the Claims team.
    • Recognize and fix areas of weakness in the system to limit potential for fraud
    • Carry out regular hospital quality checks.
    • Develop and implement survey tools for patient feedback and communicating data results to Providers to ensure continuous improvement.
    • Visit patients in the hospital to ensure they are getting medically necessary care, quality care and that the care is being delivered as efficiently and economically as possible.
    • Anticipates the patient’s future health care needs and tries to put in place mechanisms to meet those needs as efficiently as possible
    • Ensure efficiency and cost effectiveness of medical services provided to clients
    • Takes initiative to present ideas and suggestions to leadership
    • Maintains knowledge and proficiency in medical practices through continuing education, staff meetings, and workshops.
    • Perform all other duties as assigned.

    Requirements
    Must Haves:

    • Must be a Medical Doctor with at least 2 years of experience in similar role.
    • Strong ability to make judgment on medical / surgical cases in relation to benefits listed on enrollee’s plan.
    • Ability to make professional judgment on coverage and non-coverage of care requests per time, based on the enrollee’s benefits table.
    • Exceptional problem solving and analytical skills
    • Excellent communication and presentation skills
    • knowledge of, and sensitivity to, cultural and language differences.
    • Must be able to work as a team member and develop productive and cooperative working relationships with all members of the RHMO team
    • A demonstration of curiosity, love for learning, execution and speed.

    Some Perks and Benefits

    • Daily meals
    • Employee-friendly working conditions
    • Generous health insurance package; including gym passes
    • Modern, cosy and collaborative workspace.

    go to method of application »

    Customer Success Quality Specialist

    The Position

    • The ideal candidate is a Medical Doctor who will work with our Customer Success team and make sure that excellent and high quality service is provided to our clients across all communication channels.
    • Your major responsibility will be to clarify medical enquiries from Providers and Enrollees as well as train the Customer Success team on the description of medical terms so as to ensure that all queries coming into the customer success department are resolved fully within the team.

    Key Responsibilities

    • Accomplish quality assurance objectives by orienting, training and coaching customer success team on medical terms
    • Develop and Implement quality assurance best practices, as well as a robust performance measurement model which will provide a basis for performance monitoring, and management.
    • Drive down incident rate of customer success agents requesting medical clarification from other sources / teams.
    • Enhance customer relationship in order to meet organizational and operational objectives
    • Carry out periodic coaching sessions to provide both qualitative and quantitative feedback based on the employee’s performance
    • Ensuring clients (corporate customers, retails customers, distribution partners and providers) have a seamless encounter with using our service.
    • Obtain client information by answering telephone calls; interviewing clients; verifying information.
    • Respond to all Enrollee and Provider inquiries and handle any complaints
    • Take telephone calls on behalf of Reliance HMO in order to fulfil customer requirements.
    • Have the most up to date information on all plans of Reliance HMO and be able to help customers in a quick and friendly fashion.
    • Maintain communication equipment by reporting any faults promptly
    • Maintains knowledge and proficiency in medical practices through continuing education, staff meetings, and workshops.
    • Perform all other duties as assigned.

    Qualifications

    • Must be a Medical Doctor
    • Willingness to work shifts across Monday to Sunday
    • Strong ability to make judgment on medical / surgical cases in relation to benefits listed on enrollee’s plan.
    • Ability to make professional judgment on coverage and non-coverage of care requests per time, based on the enrollee’s benefits table.
    • Excellent communication and presentation skills
    • Must be able to transfer knowledge to other team members

    Benefits
    You’ll love this opportunity because:

    • You'll have a clear career path
    • You'll have a lot of independence in managing projects
    • We have a vibrant and active culture
    • Co-workers are a close - knit, intelligent, and motivated team.
    • Daily meals
    • Employee-friendly working conditions
    • Generous health insurance package; including gym passes
    • Modern, cosy and collaborative workspace

    Method of Application

    Use the link(s) below to apply on company website.

     

  • Send your application

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