Quality Business Analyst
Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals. If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole-person health.
The Quality Business Analyst works collaboratively with business areas to ensure compliance with established metrics and adherence to policies and procedures. Through an auditing process, analysts identify areas of improvement, system inconsistencies, and training opportunities.
Responsibilities
• Specific duties include, but are not limited to:
• Review operational activities end-to-end to ensure accuracy and completeness.
• Provide timely documented feedback on issues identified at the processor and/or system level and initiate escalation procedures when necessary.
• Work collaboratively with the business areas to identify areas of improvement and opportunities for efficiencies.
• Auditing call center transactions for accuracy and completion of information
• Provide timely documented feedback on issues identified at the processor and/or system level and execute escalation procedures if applicable.
• Identify process improvements and develop workflow and/or system recommendations.
• Perform analysis to help identify trends and detect the root cause of deficiencies.
• Support assigned projects, maintain appropriate documentation at a task level, monitor deadlines, and service as a technical liaison when appropriate.
• Develop and maintain user documentation, ensuring the most current information is available to the production areas.
• Communicate effectively in writing and verbally within work groups and internal and external customers.
• Attend internal and external education training to achieve and maintain proficiency in all systems and processes.
• Perform other duties as assigned.
Qualifications/Skills:
• Minimum 3 to 5 years of quality review, auditing client setup, or claims processing experience.
• Bachelor’s Degree preferred.
• Demonstrated self-starter with strong problem-solving, attention to detail, analytical, organizational, and writing skills.
• Knowledge of systems, process flows, and timelines to ensure requirement testing and implementation are compliant across operational disciplines.
• Ability to compile detailed system requirements, reporting, and data mining to support business needs.
• Skilled in trend analysis and highly effective in communicating as the liaison with business partners on findings and recommendations focused on minimizing impacts to other areas and the customer.
• Superior written and verbal communication skills are required to provide business partners with information and tools to support system modifications and/or new implementations.
• Maintain flexibility in a team environment identify process improvement opportunities and define system impacts that may result.
• Working knowledge and experience with Healthcare Plans, Claims Processing, Benefits Plan Booklets, and customer service
• Foundational knowledge of systems including, Front Office System (FOS), Health Rules Payor (HRP), Tableau, and Service Now (SNOW)
.
Hybrid
Independence has implemented a “Hybrid” model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the “Hybrid” model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.
Independence Blue Cross is an Equal Opportunity and Affirmative Action 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.
Diversity, Equity, and Inclusion
At Independence, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that 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. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the 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
Independence Blue Cross is an Equal Opportunity and Affirmative Action 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.