Director of QA & Compliance
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The Director of Quality Assurance & Compliance is responsible for managing the Quality Assurance function across all business lines. This role involves supporting the business's strategic objectives and meeting the broader corporate quality assurance, internal and external audit, and compliance requirements. The position will collaborate with call center, claims, and other operational leaders, as well as the Compliance and Internal Audit teams, to enhance the efficiency and accuracy of transactions.
Description
· Continuously develop and implement quality assurance programs to ensure accuracy and efficiency in call center operations, claims processing, and enrollment and billing based on business needs.
· Optimize quality programs to utilize more automated tools and critically focus on system assessments to improve system throughput.
· Accountable for all operational transaction auditing associated with regulatory compliance audits and client Performance Guarantees (PGs) reporting.
· Establish a collaborative partnership with internal business partners to facilitate problem-solving, provide root cause analyses, and maintain operational oversight to reinforce high-quality performance.
· Champion and own cross-functional remediation of issues and process improvements as necessary.
· Monitor and provide operational performance metrics and additional trend analysis to monitor operational metrics on daily, weekly, and monthly basis.
· Actively manages professional development of direct reports and provides motivation, recognition, and leadership through coaching, counseling, and performance appraisals.
· BA/BS in Information Systems, Computer Science, Business Administration, Data Analytics, or related field or equivalent experience.
· Minimum of 7-10 years of experience in quality assurance and compliance within the health insurance industry.
· In-depth knowledge of health insurance regulations, including HIPAA, ACA, and other relevant regulations.
· Proven track record of successfully managing quality and compliance programs. Strong experience in insurance claims handling and administration
· Thinks creatively; seeks out and explores alternative approaches to problem solving and the identification of potential solutions.
· Very strong analytical and technical skills in using data analytics to investigate root causes for deficiencies and effectiveness of controls
Inclusion and Belonging
At IBX, everyone can feel valued, supported, and comfortable to be themselves, and all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. Celebrating and embracing diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
About Our Company
Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.
At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!
Equal Employment Opportunity
IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Agency Disclaimer
All resumes submitted directly to an Independence Blue Cross employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of Independence Blue Cross and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.