Quality Business Analyst

Independence Blue Cross - Philadelphia, PA

Full-time

Philadelphia, PA

Insurance Carriers and Related Activities

About the position

The Quality Business Analyst plays a crucial role in ensuring compliance with established metrics and adherence to policies and procedures within the organization. This position involves collaborating with various business areas to identify areas for improvement, conducting audits, and providing feedback to enhance operational efficiency. The analyst will also support projects, maintain documentation, and communicate effectively with internal and external stakeholders.

Responsibilities

• 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.
• Audit call center transactions for accuracy and completion of information.
• 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 serve 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 on all systems and processes.
• Perform other duties as assigned.

Requirements

• 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 to 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).