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Quality Manager

Location:
Hyderabad, AP, 500010, India
Salary:
3 to 3.5L per annum
Posted:
August 30, 2012

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Resume:

RESUME

Lalitha Raju

Flat No S*, IInd floor, LakeView Apts

Alwal, Secunderabad

Phone:+91-040-996-***-****, 812*******

E-mail :rbcx8t@r.postjobfree.com

___________________________________________________________________

Profile:

People Manager for 2 years of proven track record in varied fields .

Professional Experience:

1. Sepal Info Services Pvt Ltd.

Position : People Manager

Job Responsibilities:

Interacting with the client with regard to the process.

Preparation of Regular and Ad hoc reports and presenting the same to management and Client.

Responsible for coordinating and overseeing training of new recruits, monitoring the call volumes and maintaining quality standards.

On-site Responsibilities:

Understand actual processes & document process flow.

Coordinated the arrangements for software access and processing from Hyderabad.

Re-design process flow to accommodate offshore processing in coordination with the client; with emphasis on coordination of production and quality audit processes.

Defined time lines for migration and quality standards to be achieved in a phased manner.

Establish points of contact during the training .

Operations Set-Up

Define & prepare processes implementation plans, plan and devise the resource requirements and set up the delivery model.

Instrumental in handling the recruitment process and setting up the team.

Responsible for total migration of the processes, including acting as a liaison between the Indian office and the client, and responsible for conducting training programs on the process.

Planning about productivity based on client requirement, and devising means of reaching the target production.

Other Responsibilities:

Assisted the HR personnel in recruitment activities. Instrumental in handling the recruitment process right from screening the resumes till the last round of interviews and setting up the teams.

Involved in designing the appraisals format and conducting the same for team members.

Involved in the sales pitch to prospective clients, though web-based presentations & demos.

2. Karvy Global Services (Oct 04 - 2008 )

KGS is a leading third party administrator (TPA), dealing with high-end offshore clients. It is involved in providing administrative services to the US healthcare sector. The company provides offshore capabilities to self-funded companies, TPA’s etc, to perform the administrative functions

Position: Team Leader-Operations

Achievements:

Successfully migrated the Clients processes to India and have played a key role in setting up the new application including setting up the training, reporting systems & coordination of operations.

Experience of working of Insurance Data Processing and also claims adjudication related to US Health care System.

Nature of Job:

Selection of member / patient and verify whether the benefits paid are in alignment with the services provided.

Verify the patient eligibility, provider status, authorization pre-requisites and other criteria before making a decision to pay or deny the claim.

Adjudicating high-value dollar claims, such as Inpatient hospitalization, DME, ESRD claims.

Job Responsibilities:

Interacting with the client with regard to the process.

Responsible for processing & adjudicating Medical / Hospital Claims.

Preparation of Regular and Ad hoc reports and presenting the same to management and Client.

Responsible for coordinating and overseeing training of new recruits, monitoring the adjudication volumes and maintaining quality standards.

On-site Responsibilities:

Understand actual processes & document process flow.

Coordinated the arrangements for software access and processing from Hyderabad.

Re-design process flow to accommodate offshore processing in coordination with the client; with emphasis on coordination of production and quality audit processes.

Defined time lines for migration and quality standards to be achieved in a phased manner.

Establish points of contact during training and migration of processes

Operations Set-Up

Define & prepare processes implementation plans, plan and devise the resource requirements and set up the delivery model.

Instrumental in handling the recruitment process and setting up the team.

Responsible for total migration of the processes, including acting as a liaison between the Indian office and the client, and responsible for conducting training programs on the process.

Planning about productivity based on client requirement, and devising means of reaching the target production.

Quality Initiatives:

Responsible for meeting & maintaining the quality requirements, monitoring the quality standards & being actively involved in auditing of claims

Set up an in-house audit team responsible for auditing claims and ensuring improved quality standards.

Encourage regular, constructive discussion between Team members regarding the performance and progress of the Jr. associates in meeting Goals and expectations (Quality Benchmarks etc.).

Other Responsibilities:

Assisted the HR personnel in recruitment activities. Instrumental in handling the recruitment process right from screening the resumes till the last round of interviews and setting up the teams.

Involved in designing the appraisals format and conducting the same for team members.

Involved in the sales pitch to prospective clients, though web-based presentations & demos.

Achievements:

Awarded Best performer and also awarded for contributing successfully for getting the Project.

Awarded the certificate of excellence for consistency and hard work.

Awarded a certificate for the best team.

Awarded the certificate of consistency for meeting the quality and work standards.

Job Responsibilities:

Processing of medical insurance claims of and for American Hospitals. The various procedures involved in the processing include online claim status verification, Analyzing the claim and processing the claim..

Meeting productivity and quality levels according to set targets and standard.

Also underwent training for Accent and Speech Clarity

Mentoring new recruits on the project.

Encourage regular, constructive discussion between Team members regarding the performance and progress of the associates in meeting Goals and expectations (Quality Benchmarks etc.).

Responsible for improving the overall job understanding of the Team members.

Preparation of Regular and Ad hoc reports and presenting the same to management and Client.

Andhra Vision InfoTech (2000-2003)

Position: Process Associate

Understand actual processes & document process flow.

Coordinated the arrangements for software access and processing from Hyderabad.

Re-design process flow to accommodate offshore processing in coordination with the client; with emphasis on coordination of production and quality audit processes.

Processing of medical insurance claims of and for American Hospitals. The various procedures involved in the processing include online claim status verification, Analyzing the claim and processing the claim..

Meeting productivity and quality levels according to set targets and standard.

Mentoring new recruits on the project.

Encourage regular, constructive discussion between Team members regarding the performance and progress of the associates in meeting Goals and expectations (Quality Benchmarks etc.).

Responsible for improving the overall job understanding of the Team members.

Preparation of Regular and Ad hoc reports and presenting the same to management and Client.

Academic Qualification:

B.Com from Osmania University

Other Qualification:

Diploma in computer application.

Typewriting Lower Grade. (Speed: 60WPM)

Personal Profile:

Husband’s Name : P.S. Raju

Date of Birth : 16th April 1968.

Languages known : English, Hindi, Telugu, Tamil and Malayalam.

Date:

Place: Secunderabad. (Lalitha Raju)



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