Training And Quality Manager

Key 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.