MetLife

US QA CSC Email Review

Position Title:  

Quality Team Leader

Reports to (Responsibility Level): UM/Manager -Quality

Supervises:  NA 

Location: 

Jaipur

Global Grade: 

GG -10

Complexity: C5T5

PID/s Load Mapping: 

N/A

Position Summary

The Quality Reviewer will be responsible for leading the quality assurance function within the CSC Email Review process. This role involves reviewing and analyzing claim submissions, ensuring adherence to policy provisions, and maintaining high standards of accuracy, compliance, and customer service. The Quality reviewer will also provide feedback, coaching, and performance insights to the claims team, drive continuous improvement, and collaborate with internal and external stakeholders to resolve escalations and enhance process efficiency.

Job Responsibilities

Quality Review & Analysis

·        Conduct detailed QA reviews of CSC Email submissions across multiple coverages and complexities.

·        Ensure claims are adjudicated in accordance with policy provisions and regulatory guidelines.

·        Identify errors, inconsistencies, or gaps in claim documentation and adjudication.

·        Analyze trends in claim processing errors and provide actionable insights.

Feedback & Coaching

·        Provide structured feedback to claim examiners based on QA findings.

·        Coach team members to improve accuracy, compliance, and customer service.

·        Mentor new hires and support their onboarding and training.

Performance Monitoring & Reporting

·        Prepare and analyze performance scorecards and quality metrics.

·        Generate custom reports from various data sources to monitor team and individual performance.

·        Review and interpret QA data to identify areas for improvement.

Process Improvement & Compliance

·        Recommend process enhancements based on QA findings and root cause analysis.

·        Ensure compliance with internal policies, external regulations, and information security standards.

·        Support UAT (User Acceptance Testing) for system enhancements and workflow changes.

Stakeholder Management

·        Handle escalations from internal teams and external customers with professionalism and urgency.

·        Collaborate with onshore management and client representatives to ensure alignment and transparency.

·        Participate in client interactions and represent the QA function in governance forums.

Workforce & Team Management

·        Support workforce management activities including scheduling, staffing, and attrition control.

·        Motivate and engage team members to achieve quality and productivity goals.

·        Ensure team members understand their goals and how they align with organizational quality objectives.

Education, Experience, Skills & Other Critical Requirement

Education

Bachelor’s degree (Any Stream) with a minimum of 15 years of education.

Experience 

(In Years)

Professional with 5+ years of work experience 

Skills

• Good knowledge of MS Office Suite
• Good computer navigation skills with keyboard speed
• Proficient in Email Management
• Knowledge of Insurance principles in relation to the US Insurance industry
• Strong knowledge of Quality function, Sampling method, root cause analysis, 7 QC tools.
• Communication skills – should be able to read, interpret business documents.
• Good verbal/written communication
• Proficiency in English – Spoken and Written
• Analytical and interpersonal skills
• Escalate issues if required
• Data gathering ability/ Eye for detail
• Teamwork/ Managing Self / Adaptability
• Adaptability to change
• Self-disciplined and result oriented
• Ability to multitask

Other Critical Requirements Like Voice/ Non-Voice for Insurance Ops

Complexity Scale: C5T5 (Domain SMEs, Good communication skills and ability to coordinate with multiple stakeholders via email/calls)