Manager Quality & Training – US Healthcare

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Manager, Quality & Training – US Healthcare

Schedule : Night Shift + Onsite

Job Title: Manager, Quality & Training – US Healthcare

Location: Philippines (supporting U.S.-based healthcare clients)

Department: Operations – Contact Center & Claims Adjudication

Reports To: VP, Operations

Supports: U.S.-based Healthcare Clients

Tasks:

The QA & Training Manager is responsible for designing, standardizing, and leading quality assurance and training programs across all U.S. healthcare accounts supported by the Philippines and US operations.

This role ensures consistent onboarding, certification, quality enforcement, and continuous performance improvement across both contact center and claims adjudication teams.

The position is highly client-facing and will work directly with U.S.-based client training and QA teams to ensure calibration, material approval, and alignment to contractual quality standards.

Priority focus will be placed on high-risk or underperforming accounts requiring structured turnaround support.

This is a hands-on leadership role. The QA & Training Manager must be willing and able to step into the operation when necessary — facilitating live training, conducting nesting support, performing QA reviews, and even processing claims or handling calls to fully understand workflows and gaps.

This leader is expected to model operational ownership, not operate solely at a strategic level.

This role is not purely administrative or strategic. The successful candidate must be comfortable rolling up their sleeves and actively participating in training delivery, QA auditing, and operational support. We are seeking a leader who understands the work because they have done the work.

Responsibilities

Training Program Development & Standardization

· Design and implement standardized onboarding programs for:

o Contact center agents (Commercial, MA, ASO, etc.)

o Claims adjudicators (Professional, Institutional, COB, Adjustments, Recovery)

· Build structured training curricula, modules, lesson plans, and facilitator guides.

· Develop knowledge, assessments, and certification requirements.

· Establish formal certification and re-certification standards.

· Ensure all accounts follow a consistent enterprise training framework.

· Prioritize high-risk accounts and implement targeted training remediation plans.

· Personally facilitate new hire and remediation training sessions as needed.

· Conduct live QA audits and side-by-side coaching sessions.

· Step into production (claims processing or call handling) when necessary to understand workflow challenges.

· Participate in nesting, go-lives, and high-risk account stabilization.

· Maintain working knowledge of all supported roles across contact center and claims functions.

· Build credibility with frontline teams by demonstrating subject matter competence.

Quality Assurance Governance

· Define and enforce minimum QA standards across all accounts.

· Standardize QA scorecards across contact center and claims functions.

· Lead weekly and monthly calibration sessions (internal and client-facing).

· Ensure QA standards align with client SLAs and compliance requirements.

· Identify systemic trends and partner with Operations leadership on corrective actions.

· Drive measurable QA improvement initiatives.

Client Engagement & Alignment

· Serve as primary Philippines-based QA/Training liaison to U.S. clients.

· Collaborate directly with client training and QA teams to:

o Review and approve materials

o Align scoring methodology

o Conduct joint calibrations

· Participate in client calls, operational reviews, and QBRs.

· Present training effectiveness and QA performance metrics.

Reporting & Performance Analytics

· Develop reporting dashboards for:

o QA scores and trends

o Error categories

o Training completion and certification rates

o Remediation effectiveness

· Provide executive summaries to U.S. Operations leadership.

· Track correlation between training interventions and performance improvements (QA %, TAT, SLA adherence).

Compliance & Risk Management

· Ensure training content aligns with:

o U.S. healthcare regulations

o HIPAA requirements

o Client-specific compliance standards

· Maintain documentation governance and version control.

· Ensure audit readiness across all accounts.

Qualifications

Required

· 7+ years experience in U.S. healthcare operations (contact center and/or claims adjudication).

· 3+ years in QA and/or Training leadership role.

· Strong knowledge of:

o U.S. Professional & Institutional claims processing

o Medicare Advantage and Commercial products

o Contact center service level environments

· Experience building training programs and QA frameworks from the ground up.

· Experience conducting client-facing calibration sessions.

· Strong English communication skills (verbal and written).

· Demonstrated experience personally delivering training (not just overseeing trainers).

· Hands-on QA auditing experience.

· Prior experience performing claims adjudication and/or contact center agent responsibilities.

· Proven ability to stabilize underperforming teams through direct involvement.

· Comfortable working in fast-paced, high-accountability environments

Preferred

· Experience supporting U.S. healthcare clients from offshore environment.

· Background in health plan or payer operations.

· Exposure to Instructional Design.

· Experience implementing LMS platforms.

· Six Sigma / Lean certification.

· Experience stabilizing underperforming or high-risk accounts.

Send CVs for screening!