Role Proficiency:

A Voice Lead leads a team of customer support associates to achieve process outcomes meet SLAs and manage client expectations. rnA Data Lead leads a team of process associates to achieve process outcomes meet SLAs and manage client expectations.

Outcomes:

With the right coaching and supervision a Lead will be able to do the following:

     Service Level Agreement (SLAs) specified by the Client in terms of quality productivity and schedule managed to ensure 100% adherence for self as well as team.      Voice: Monitoring live and remote) cases and give effective feedback to close transactions.      Data: Perform QC and QA to ensure process and output quality and give feedback to associates to ensure smooth functioning.      Communicate with clients daily and provide status updates; obtain feedback and act immediately to resolve any issues reported by the client      Track and update process documentation and get sign off from client for closure      Ensure schedule adherence for daily/weekly/monthly reporting to clients      Focus on innovation within the team and processes to increase operational efficiency by automating standard tasks.      Manage the larger team and provide focus and guidance to ensure minimal errors reported

Measures of Outcomes:

     100% Adherence to quality standards process and SLA’s      Number of issues fixed/tasks completed      Number of non-compliance issues with respect to SOP      Zero/No Client Escalations      % of QC and QA scores      RCA and Corrective Action Plans      Daily/weekly performance reporting      Number of high-quality RCA and QA output      Mentors A1 A2 A3 and B1 Associates.   Swift turnaround time for response and resolution   Update SOPs and job aids on a weekly basis   Delegate tasks and set deadlines for the team

Outputs Expected:

Production: Take escalated calls (voice) or manage completion of escalated/complex transactions (data).
Adherence: Manage work intake
allocation and completion in adherence to SLAs. Thorough understanding of organization and customer defined process. Consult with mentor when in doubt. Adherence to defined processes. Adhere to organization’ s policies and business conduct. Ensure adherence to schedules
Quality: Responsible for creating quality plans and implementing quality management function.
Monitoring: Responsible for call monitoring
coaching and feedback; responsibility of the delivery of defined customer experience. Monitors progress of requests for support and ensures users and other interested parties are kept informed. Responsible for call monitoring
coaching and feedback; responsibility of the delivery of defined customer experience. Monitors progress of requests for support and ensures users and other interested parties are kept informed.
Issue Resolution: Showcase ownership and resolve problems and issues quickly to avoid related losses and escalations. Perform resolution exercises and quality calibration with clients and ensure 100% participation. By means of RCA
huddles
training need analysis
corrective action plans; ensure improvement of quality scores. Identifies
analyses and solves the incidents/transactions.
Reporting: Create reports on specific SLAs/performance measures/KPIs
Team management : Set expectations
manage performance of team and individuals. Provide regular feedback. Actively participate in team/organization-wide initiatives. Provide coaching
training and guidance to new team members to engage and build productivity of team. Recognize high performance and reward accomplishments. Work closely with team members to solve customer problems. Understand agent's problems and weaknesses and address these.
Operational Management: Managing the floor effectively and efficiently with no errors and high productivity.
Escalation: Escalate problems to appropriate individuals/support team based on established guidelines and procedures.
Manage knowledge: Consume project related documents
share point
libraries and client universities
Release: Adhere to release management process
Mentor: Mentoring and providing guidance to peers and junior associates
Communication: Provide status update to the respective stakeholders and within the team
Training: On time completion of all mandatory training requirements of organization and customer. Provide on floor training and one-on- one mentorship for new joiners. Attends need-based domain/project/technical trainings as needed
Collaboration: Collaborate with different towers of delivery for quick resolution (within SLA)
document learnings for self-reference. Collaborate with other team members for timely resolution of errors. Assist new team members to understand the customer environment.
Performance Management: Update FAST Goals in NorthStar
track
report and seek continuous feedback from peers and manager. Set goals for team members and mentees and provide feedback

Skill Examples:

     Customer Focus: Focus on providing a prompt and efficient service to customers; goes out of the way to ensure that individual customer needs are met.      Attention to detail to ensure team follows SOPs and does not make unintentional errors      Team Work: Respect others and work well within the team.      Communication: Speak clearly and write in a clear and concise manner. Uses appropriate style and language for communication (Data)      Communication: Speaks in an accent neutral manner or with the accent required for the process with good vocabulary and grammar skills. Writes clearly (Voice)      Analysis and Decision Making: Makes systematic and rational judgments based on information and relevant assumptions.      Makes rule based and discretionary decisions      Team coaching: Provide feedback on quality and production issues; perform root cause analysis and create corrective action plans      Team leadership: Guides and supports the efforts of the team members towards the achievement of the team objectives. Sets expectations and manages feedback. Proactive in avoiding or resolving conflicts.   Excellent communication and leadership skills.   Organizational and time management skills.   Ability to follow SOP documents and escalate the s within the defined SLA   Willingness and ability to learn new skills domain knowledge etc.   Sr. Team Leader/Sr. Domain Expert/Sr. Training Lead/Sr. QA Lead/Sr. Process Excellence Lead   Quality Auditors SME Domain Experts Trainers Six Sigma specialists

Knowledge Examples:

     Familiar with Windows Operating Systems MS Office      English comprehension – reading writing and speaking      Domain knowledge based on process (healthcare banking investment F&A retail customer support etc)      Expertise in process knowledge and guidelines      Expertise with work allocation and intake functions      Expertise in MS Excel      Team and people management experience      Expertise in quality control processes including pare to analysis and root cause analysis      Excellent understanding of customer infrastructure ability to co-relate failures   Experience level – 7 to 11 years

Additional Comments:

About UST HealthProof At UST HealthProof, you will join a fast paced, growing company in our mission to reshape the future of health insurance through significantly reducing administrative costs and building better healthcare experiences for our health plans customers and their members. By creating a modern, cloud based, Best-In-Class core administration ecosystem, we have made healthcare more affordable and helped our health plans operate more efficiently. Through member and provider touchpoints with less friction, we have created real impact for members. UST HealthProof is run by leaders with strong health plan and technology backgrounds who have start-up mindsets and an environment of support where individual growth is nurtured. You will be supporting our proven core admin solutions and business process-as-a-service (BPaaS) operations to provide transparency, improve operational efficiency, and break down operational barriers to scale and drive strategic growth. UST HealthProof is looking for Claims Team Lead, reporting to the Claims Manager. The Claims Team Lead is responsible for a team of 12-15 claims examiners, adjusters, extensive interaction with client organization, and multiple stakeholders. The Claims Team Lead is accountable for delivering a high-quality claims operation, meeting and exceeding all service level agreements and KPIs, driving operational excellence, and building competencies for delivery. As a Claims Team Lead at UST HealthProof, this is your opportunity to • Be responsible for directly managing a staff of 12 - 15 associates • Be responsible for knowing and meeting client-specified guidelines • Be responsible for monitoring and management of the downline staff’s productivity targets and financial and procedural accuracy standards as established by management • Collaborate on special projects as assigned by the manager; special projects can include process documentation development, training, quality audits, assisting with surge activity for the client(s), or any other project as determined by management • Establish and maintain an appropriate level of communication with management to address issues and concerns and take preventive measures that ensure processing accuracy and quality • Assemble and assign projects that may include provider data, authorizations, enrolment, or other information • Perform other duties as assigned by your leadership You bring: • Solid understanding and ability to effectively lead a claims team • 5+ years healthcare claims processing experience • Good communication skills (verbal and written) • ICD-10 CPT and HCPCS coding is a plus • Knowledge base of physician billing and hospital coding (ICD-10, HCPC, CPT-4), medical terminology, and authorization requirements • Willingness to learn new skills • Team collaborator • Strong work ethic For this role, we value: • The ability to adapt quickly to a fast-paced environment • A self-starter and quick learner • Team player with an ability to collaborate • Ability to coach the team to reach their full potential