Role Overview
The Service Quality Manager is responsible for end-to-end management of complaints, ensuring timely investigation, resolution, and closure in alignment with service standards and regulatory expectations. The role works closely with CRM and internal stakeholders (Claims, Contact Centre, Provider Network) to drive structured investigations, identify root causes and implement corrective/ preventive actions.
This role requires strong operational and claims knowledge with a focus on quality assurance, governance and continuous improvement.
Key Responsibilities
1. Complaint Management & Resolution
- Oversee the full lifecycle of complaints from intake to closure.
- Partner with CRM to ensure complaints are tracked, updated, and closed within agreed timelines.
- Ensure responses are clear, accurate, and aligned with internal policies and client expectations.
2. Investigation & Root Cause Analysis
- Lead detailed investigations by coordinating with Claims, Contact Centre and relevant stakeholders.
- Perform structured root cause analysis (RCA) to identify gaps in processes, systems, or execution.
- Ensure documentation of findings is thorough, accurate and audit-ready.
3. Stakeholder Management
- Act as the central point of coordination between CRM and operational teams.
- Engage internal stakeholders to obtain necessary inputs and drive accountability for resolution.
- Align on response positioning to ensure consistency in communication to clients and members.
4. Quality Assurance & Governance
- Ensure complaint handling adheres to internal SOPs, SLAs and regulatory requirements.
- Identify recurring issues and escalate systemic risks to management.
- Support audits and reporting requirements related to complaints and service quality.
5. Continuous Improvement
- Translate complaint insights into actionable improvements across operations and claims processes.
- Work with stakeholders to implement preventive measures and track effectiveness.
- Contribute to service quality frameworks, policies, and training initiatives.
Experience:
- Minimum 6–10years in healthcare operations, claims, or service quality roles.
- Prior experience handling complaints, escalations, or service recovery is preferred.
Functional Knowledge:
- Strong understanding of claims processes, policy interpretation, and operational workflows.
- Familiarity with CRM systems and complaint tracking frameworks.
Skills & Competencies:
- Meticulous with strong attention to detail.
- Excellent written and verbal communication skills, with the ability to manage sensitive situations.
- Strong analytical and problem-solving skills with a structured approach to RCA.
- Ability to manage multiple stakeholders and drive outcomes under tight timelines.
- High level of accountability and ownership.
