Careers

Duties & Responsibilities:

• Quality Assurance Activities

1. Conduct routine quality checks and audits on operational processes, transactions, and case files.
2. Review adherence to approved policies, procedures, and Modus Operandi (MOPs).
3. Identify errors, inconsistencies, and non-compliance issues and document findings.
4. Support corrective and preventive action plans in coordination with relevant departments.
5. Participate in quality calibration sessions and quality improvement initiatives.

• Network Relations Support & Implementation

1. Support the implementation of GlobeMed’s network strategies, policies, and procedures.
2. Assist in communicating GlobeMed’s policies, protocols, and updates to healthcare providers.
3. Maintain day-to-day coordination with providers to support effective working relationships.
4. Follow up with providers to ensure alignment with agreed terms and operational requirements.

• Research & Analysis

1. Collect, analyze, and interpret operational data to identify trends, risks, and improvement opportunities.
2. Conduct ad-hoc research and benchmarking studies related to healthcare operations, claims, network, or customer service.
3. Support root-cause analysis for recurring issues and service gaps.
4. Prepare research summaries and analytical reports for management review.

• Reporting & Documentation

1. Prepare quality assurance reports, dashboards, and performance summaries.
2. Maintain proper documentation of quality findings, research outputs, and follow-up actions.
3. Support the development and updating of QA guidelines, checklists, and reporting templates. 

• Compliance & Process Improvement

1. Ensure QA activities comply with internal policies, contractual requirements, and regulatory standards.
2. Support process improvement initiatives by providing data-driven insights and recommendations.
3. Monitor implementation of corrective actions and report progress.

• Coordination & Support

1. Coordinate with operations, medical, IT, and customer service teams to support quality and research activities.
2. Support training and awareness sessions on quality standards and process improvements when required.
3. Respond to management requests related to quality analysis and operational research.

Qualifications: 

• Bachelor’s degree in Business Administration, Healthcare Management, Data Analytics, Insurance, or a related field.
• Health insurance diploma or quality certification is an advantage.
• 4+ years of experience in quality assurance, operations, research, or analytics within healthcare, insurance, or TPA environments.
• Understanding healthcare operations, insurance processes, and quality standards.
• Experience with data analysis and reporting tools (Excel, dashboards, basic BI tools).
• Strong analytical and attention-to-detail skills.
• Ability to interpret data and translate findings into actionable insights.
• Good reporting and documentation skills.
• Effective communication and coordination abilities.
• Problem-solving mindset and continuous improvement orientation.