Manager, Quality & Training – US Healthcare | Hybrid

Manager, Quality & Training – US Healthcare

Location: Makati, Phils.

Work Set-up: Hybrid
Department: Operations – Contact Center & Claims Adjudication
Reports To: VP, Operations

Position Summary

The QA & Training Manager is responsible for designing, standardizing, and leading quality assurance and training programs across all U.S. healthcare accounts supported by the Philippines and US operations.

This role ensures consistent onboarding, certification, quality enforcement, and continuous performance improvement across both contact center and claims adjudication teams.

The position is highly client-facing and will work directly with U.S.-based client training and QA teams to ensure calibration, material approval, and alignment to contractual quality standards.

Priority focus will be placed on high-risk or underperforming accounts requiring structured turnaround support.

This is a hands-on leadership role. The QA & Training Manager must be willing and able to step into the operation when necessary — facilitating live training, conducting nesting support, performing QA reviews, and even processing claims or handling calls to fully understand workflows and gaps. This leader is expected to model operational ownership, not operate solely at a strategic level.

This role is not purely administrative or strategic. The successful candidate must be comfortable “rolling up their sleeves” and actively participating in training delivery, QA auditing, and operational support. We are seeking a leader who understands the work because they have done the work.

Key Responsibilities

Training Program Development & Standardization

Design and implement standardized onboarding programs for:

Contact center agents (Commercial, MA, ASO, etc.)

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:

Review and approve materials

Align scoring methodology

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:

QA scores and trends

Error categories

Training completion and certification rates

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:

S. healthcare regulations

HIPAA requirements

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:

S. Professional & Institutional claims processing

Medicare Advantage and Commercial products

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.

Core Competencies

Structured and process-driven

Data-oriented decision making

Strong facilitation skills

Executive presence with clients

Cross-functional collaboration

Change management capability

Ability to influence without direct authority

Operational credibility

Servant leadership mindset

Willingness to lead from the front

Accountability-driven

High urgency with high-risk accounts

Other Requirements

• Amenable to work US hours (night shift)

• Willing to report onsite -Makati as required by business needs.

What We Offer

• Comprehensive HMO Coverage (Medical/Dental)

• Coverage on Day1 + 1 Free Dependent

• Competitive Salary

COMPANY OVERVIEW:

Imagenet LLC is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans’ members and providers.

The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans’ members and providers. The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually. The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients.

Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.