Pre Authorization - Team Coach & Team Lead

Role & responsibilities

• Lead and manage a team handling Pre-Authorization initiation, follow-up, status verification, and authorization-related voice processes with insurance companies and TPAs.
• Ensure the team consistently meets defined quality, productivity, SLA, turnaround time, and compliance targets.
• Monitor and evaluate authorization calls to ensure accurate verification of insurance eligibility, benefits, authorization requirements, payer guidelines, and client-specific processes.
• Ensure associates follow established SOPs, quality parameters, compliance requirements, and client guidelines while handling authorization cases.
• Conduct regular call audits, transaction audits, and process reviews to identify errors, gaps, and opportunities for improvement.
• Provide timely and structured feedback, coaching, and performance improvement plans to team members based on quality and productivity outcomes.
• Monitor authorization cases for accurate documentation, timely follow-ups, proper status updates, and complete case notes in healthcare systems.
• Ensure accurate and effective communication between providers, insurance companies/TPAs, internal teams, and other stakeholders.
• Handle and resolve complex, delayed, and escalated authorization cases, ensuring appropriate follow-up and timely closure.
• Track team performance through quality scores, productivity metrics, error trends, SLA adherence, attendance, and other operational KPIs.
• Prepare and maintain quality reports, error trackers, performance dashboards, RCA reports, and management reports.
• Analyze recurring errors and conduct Root Cause Analysis (RCA) to identify process, knowledge, communication, or system-related gaps.
• Drive Corrective and Preventive Actions (CAPA) and process improvement initiatives to improve accuracy, productivity, turnaround time, and customer/client satisfaction.
• Conduct regular calibration sessions with Quality, Operations, Training, and other relevant teams to ensure consistent interpretation and application of quality parameters.
• Partner with the Training and Quality teams to

Preferred candidate profile

• Minimum 6 + Years of experience into Pre Authorization(Semi Voice Process)
• And also minimum 6 months of experience as Team Lead on Papers