Manager Compliance & QA
Quality assurance reviews play a critical role in helping business areas assess team performance, strengthen operational effectiveness, and make data driven decisions that support process improvements and organizational change. The Manager, Quality Assurance & Compliance oversees quality assurance programs across multiple operational functions and leads a team of QA supervisors and audit professionals in driving continuous improvement and operational excellence. This role champions the organization’s strategic goals by ensuring alignment with enterprise quality standards, internal and external audit requirements, and compliance expectations. Strong partnership with Operational Leadership, Compliance, and Internal Audit is essential to enhance accuracy, efficiency, and overall transaction quality. The ideal candidate is a strong communicator and strategic thinker who demonstrates adaptability, sound judgment, and the ability to respond effectively to evolving business needs.
Key Responsibilities:
• Oversee all quality-related operational activities across customer service, client setup, appeals, enrollment, billing, and other operational areas, ensuring timely issue identification, thorough audit documentation, comprehensive analysis, and clear communication of results to Operations and Compliance teams.
• Drive process optimization initiatives and maintain rigorous standards of quality and compliance throughout the organization.
• Assume accountability for operational transaction auditing in support of regulatory compliance audits and client Performance Guarantees (PGs) reporting.
• Actively manage daily workflow, productivity, and accuracy of quality analysts to ensure consistent performance against established expectations and standards.
• Collaborate with internal business partners to facilitate effective problem resolution, conduct root cause analyses, and advocate for high-quality operational performance, promptly addressing and resolving instances of substandard quality.
• Support internal, external customer, third-party, state, and federal audits by providing required data, validating reports, and submitting documentation in accordance with all relevant guidelines and specifications.
• Deliver operational performance metrics and trend analyses across daily, weekly, and monthly intervals, partnering with Operational Leaders, Compliance, and Internal Audit to enhance efficiency, strengthen accuracy, and drive sustained process improvements.
• Deliver operational performance metrics and conduct trend analyses to monitor key metrics on a daily, weekly, and monthly basis. Ensure regular engagement with Operational Leaders, Compliance, and Internal Audit to optimize efficiency, strengthen accuracy, and drive sustained process improvements.
• Provide strategic leadership in the professional development of direct reports by fostering engagement, recognition, and growth through effective coaching, performance guidance, and development planning to support individual and team success.
• Bachelor’s degree in Business Administration, Information Systems, Computer Science, Data Analytics, or related field.
• Minimum of eight (8) years of relevant experience across various operational disciplines.
• Demonstrated expertise in quality assurance standards, including plan development, change control, and documentation practices.
• Extensive experience in administration of benefits and claims handling.
• Advanced analytical and technical proficiency in leveraging data analytics to investigate root causes of deficiencies and assess the effectiveness of controls.
• Proven ability to manage multiple projects within a dynamic development environment.
• Demonstrated proficiency in defining business solutions, making informed decisions, identifying and resolving problems, coordinating resources, and implementing organizational changes.
• Demonstrates strong attention to detail and a clear understanding of corporate objectives, with the ability to manage projects and implementations throughout their life cycle while consistently meeting established deadlines.
• Exceptional verbal and written communication skills.
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.
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.
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.