Quality Specialist
The Provider Data Quality Specialist is responsible for ensuring the accuracy, integrity, and reliability of provider data across multiple systems and workflows. This role supports operational excellence by reviewing data for quality issues, assisting with complex inquiries, and collaborating closely with internal partners to resolve provider data discrepancies. The specialist works in claims inventory, investigates and completes One Hub tasks, assists with ServiceNow (SNOW) tickets, and supports error resolution within the NextGen provider data platform PIE.
This role requires strong communication skills, the ability to work effectively in a collaborative team environment, and confidence navigating multiple systems simultaneously to identify and resolve issues.
Key Responsibilities
Provider Data Quality & Error Resolution
- Review and research provider data inconsistencies across multiple platforms, including the NextGen π system, to identify root causes of errors.
- Ensure the completeness, accuracy, and integrity of provider data through ongoing monitoring and quality checks.
- Document error trends and escalate systemic issues to the appropriate operational or technical teams.
- Maintain a strong working knowledge of provider data standards, business rules, and regulatory requirements.
Operational Support
- Work assigned claims inventory to set up non par providers needed for claims processing.
- Resolve or route One Hub tasks related to provider updates, corrections, or escalations.
- Respond to and assist with ServiceNow (SNOW) tickets involving provider data inquiries, updates, or system issues.
- Coordinate with internal teams to ensure timely and accurate updates to provider records.
Cross‑Functional Collaboration
- Partner with internal departments such as Credentialing, Claims, Pricing, and Provider to address provider data issues.
- Effectively communicate data findings, needed corrections, and process improvements to both technical and non‑technical partners.
- Participate in meetings, audits, or workgroups focused on improving provider data quality or operational workflows.
Systems & Research
Navigate and work simultaneously in multiple data systems and workflow platforms to research provider history, identify discrepancies, and validate updates.
- Perform detailed research to locate missing information, resolve returned or rejected updates, and verify provider demographics, affiliations, and identifiers.
Required Skills & Qualifications
Bachelor's degree or 2 to 3 years' experience needed.
- Excellent written and verbal communication skills with the ability to explain findings clearly and professionally.
- Ability to prioritize work in a fast‑paced environment with competing tasks.
- Experience working in multiple systems simultaneously and navigating complex workflows.
- Ability to collaborate effectively with cross‑functional teams and maintain positive working relationships.
Preferred Qualifications
- Experience working in provider data, network operations, health plan operations, or a related environment.
- Familiarity with systems such as SNOW, One Hub, claims platforms, or provider data management systems (including NextGen platform, PIE.
- Understanding of provider data workflows, including credentialing, contracting, configuration, and reimbursement.
- Knowledge of regulatory requirements related to provider directories and data accuracy is a plus.
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.