Nurse - Quality Analyst
Aguadilla, Puerto Rico
Job Type: Full Time (In Office)

Executes transactions as per prescribed guidelines and timelines, reviews and validates the inputs from the Process Executives, supports the Team Lead in training, daily review and escalation with the objective to meet SLA targets for the specific process within the guidelines, polices and norms of Infosys.

Job responsibilities:

• Responsible for Service Delivery Quality in the areas assigned
• Perform activities delegated as per Service Quality Plan
• Identify metrics to be tracked for the processes, Report the Table F performance on monthly basis
• Perform root cause identification of process failures and implementation of corrective/preventive actions
• Identify and check key controls for all process in QMS related to engagement
• Understanding Process of Transaction Monitoring, Validation of Sampling Plan on Qtr. basis, Random audit of TM process on key controls like %age audit, Sampling method adherence
• Drive project identification and closures
• Proactive Risk identification & mitigation
• Assessment of Various standards and requirements on regular basis

Essential Responsibilities

• Execute transactions as per prescribed guidelines and timelines to meet SLA targets. Participate and supports the daily huddles, provides training/input on process/ business to the team to ensure delivery predictability
• Handles/ helps resolve escalation at the process level to ensure high customer satisfaction
• Reviews and validates the inputs from Pes and creates case studies/FAQs to capture tacit knowledge
• Participate in the ideation process and produce the documentation and trains the team on the reengineered process to meet client and internal commitments on a continuous basis
• Supports the TL by training people on process/ domain as part pf the growth plan to ensure high E-Sat

Basic Required Qualifications

• High School Diploma or GED Equivalent
• At least 2 years of experience relating to the job description

Preferred Qualifications

• Puerto Rico registered Nurse License
• Fully Bilingual- English and Spanish
• Preferably experience conducting trainings
• Intermediate to advanced knowledge in using MS Office and ability to learn and use various computer software
• Experience in an office/clerical setting in the medical field
• Experience in any claim adjudication platform
• Certification in medical coding (CPT, ICD-10
• Exposure to Healthcare Claims products (Indemnity, PPO, POS/DA, EPO, HMO)
• Prefer knowledge of Workman's Compensation, Medicare, COB, no fault
• Prior claims experience in medical coding, case management, cost containment review, medical claim management will be preferred
• Exposure to anti-fraud initiatives in clinical area
• Awareness of clinical practice guidelines used by health plans to develop medical policy
• Possess eye for details
• Knowledge of Microsoft Office Products
• Team Player, Analytical, Written and Verbal Communication Skills, Interpersonal Skills and Positive Attitude

About Us
Infosys BPM Limited, a wholly owned subsidiary of Infosys Limited (NYSE: INFY), provides end-to-end transformative business process management (BPM) services for its clients across the globe. The company's integrated IT and BPM solutions approach enables it to unlock business value across industries and service lines, and address business challenges for its clients. Utilizing innovative business excellence frameworks, ongoing productivity improvements, process reengineering , automation , and cutting-edge technology platforms, Infosys BPM enables its clients to achieve their cost reduction objectives, improve process efficiencies, enhance effectiveness, and deliver superior customer experience.
Infosys BPM has 45 delivery centers in 16 countries spread across 5 continents, with 58,090 employees from 111 nationalities, as of June, 2024.
The company has been consistently ranked among the leading BPM companies globally and has received over 60 awards and recognitions in the last 5 years, from key industry bodies and associations like the Outsourcing Center, SSON, and GSA, among others. Infosys BPM also has very robust people practices, as substantiated by the various HR-specific awards it has won over the years. The company has consistently been ranked among the top employers of choice, on the basis of its industry leading HR best practices. The company's senior leaders contribute widely to industry forums as BPM strategists.

EOE/Minority/Female/Veteran/Disabled/Sexual Orientation/Gender Identity/National Origin
Infosys is an equal opportunity employer and all qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, spouse of protected veteran, or disability.