Quality Business Analyst
Role: Quality Business Analyst
Description:
The Quality Business Analyst collaborates with various business areas to ensure compliance with established metrics, company policies, and procedures. Through auditing, the analyst identifies areas for improvement, system inconsistencies, and training opportunities that enhance operational excellence and support the delivery of high-quality service to clients and members.
Key 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.
· Collaborate with business areas to identify improvement opportunities and operational efficiencies.
Also responsible for:
· Audit operational transactions, including provider, member, and vendor communications, claims, appeals, grievances, enrollment, billing and client setup, to ensure accuracy and completeness.
· Review end-to-end operational activities to verify compliance with internal standards and regulatory requirements.
· Provide timely, documented feedback on issues identified at the processor and/or system level, and initiate escalation procedures when necessary.
· Identify process improvements and develop workflow and/or system recommendations to support operational efficiencies.
· Perform analysis to identify trends and detect root causes of deficiencies, supporting continuous improvement initiatives.
· Design and execute test plans for new or modified processes, ensuring changes function as intended and comply with applicable policies and regulations. Maintain detailed testing notes and documentation.
· Communicate effectively, both in writing and verbally, with internal and external teams.
· Support assigned projects, maintain documentation at the task level, monitor deadlines, and serve as a technical liaison when appropriate.
· Attend internal and external training to maintain proficiency on all systems and processes.
· Perform other duties as assigned.
Qualifications
- Minimum 3 to 5 years of quality review, auditing, 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 requirements testing and implementation remain compliant across operational disciplines.
· Ability to compile detailed system requirements and use reporting and data mining to support business needs.
· Skilled in trend analysis and effective in communicating findings and recommendations to business partners, with a focus on minimizing impacts to other areas and customers.
· Superior written and verbal communication skills are required to provide business partners with information and tools that support system modifications and/or new implementations.
· Maintain flexibility in a team environment, identify process improvement opportunities, and define related system impacts.
- Working knowledge and experience with healthcare plans, Medicare regulations, claims processing, client setup, enrollment, and other operational areas.
· Foundational knowledge of systems, including Front Office System (FOS), HealthRules Payor (HRP), PRIME, Virtual Appeals Manager (VAM), Tableau, and ServiceNow (SNOW).
Ability to effectively work autonomously in a hybrid environmen
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.