Independence Blue Cross

Senior Quality Business Analyst

Independence Blue Cross • $85K — $110K *
Philadelphia, PA 19120In-Person
Healthcare
5 - 7 years of experience
2 days ago
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Job Overview by Ladders

Qualifications

  • 5-8 years of relevant experience in FEP Claims Processing and Quality control.
  • Experience with FEP Facility Claims audits and adjustments.
  • Bachelor's degree or equivalent work experience.
  • Strong familiarity with FEP process flows and regulatory impacts.
  • Proficient in trend analysis and data mining related to FEP.

Responsibilities

  • Review and ensure the accuracy of FEP transactions and system processing.
  • Provide documented feedback on issues found during transaction reviews.
  • Identify process improvement opportunities within the team.
  • Participate in knowledge transfer activities for cross-training.
  • Actively represent the FEP Claims Team in various projects and initiatives.
  • Develop and maintain up-to-date FEP user documentation for production areas.
  • Design and evaluate test plans for new or modified processes.

Benefits

  • Participation in internal and external training to enhance proficiency.
  • Collaboration in a team-oriented environment focusing on process improvements.
  • Opportunities to serve as a technical liaison on projects.
Full Job Description
The FEP Sr. Quality Business Analyst supports FEP Claims Operations with ensuring the quality of the transaction work performed by FEP Claims Operations and the processing vendor. The FEP Sr. Quality Business Analyst also participates in the various FEP Claims Operations transaction workstreams.
  • Review FEP transactions to ensure accuracy of transaction and
    • system processing. Provide timely documented feedback on
    • issues identified at the processor and/or system level and
    • execute escalation procedures if applicable
  • Maintain flexibility in a team environment and identify process improvement opportunities and define system impacts that may result.
  • Ability/willingness to participate in departmental knowledge transfer activities to facilitate cross-training efforts.
  • Actively represents the FEP Claims Team on various projects and possesses proven ability to identify required action items and impacts.
  • Represent FEP Claims Team on assigned projects, providing feedback and assessing impacts accordingly
  • Identify FEP process improvements and develop workflow and/or system recommendations
  • Support lead analyst or supervisor in all project related activities (analysis, tracking, etc.)
  • Develop and maintain FEP user documentation ensuring the most current information is available to the production areas.
  • Communicate effectively in writing and verbally with in work groups and internal and external customers
  • Attend internal and external education training to achieve and maintain proficiency on all systems
  • Support assigned projects, maintain appropriate documentation at a task level, monitor deadlines and budget allocations and service as a technical liaison when appropriate
  • Assist with designing test plans and evaluate/ test new or modified processes and procedures to verify that the new programs or program changes are functioning as intended and conform to established policies. Maintain detailed testing notes, cases and outcomes to support all findings

  • Familiarity with FEP process flows, regulatory impacts and timelines to ensure requirements, testing and implementation are in compliance across operational disciplines.
  • Proven experience to assess FEP regulations and required controls and incorporating what is required into the specifications and/or documentation
  • Proven ability to compile FEP detailed system requirements, reporting and data mining to support business needs that meet the need.
  • Proficient in FEP trend analysis and 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 units with FEP information and tools to support system modifications and/or new installations.

Required:
  • FEP Facility Claims Processing and adjustment experience
  • FEP Facility Claims Quality and Audit experience
  • Minimum of 5 to 8 years work related experience
  • BS/BA Undergraduate degree or equivalent related experience


Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.

About Independence Blue Cross

Independence Blue Cross (IBC) is a health insurance company based in Philadelphia, Pennsylvania. It is one of the largest health insurers in the United States, serving over 8 million people in 24 states and the District of Columbia. IBC offers a variety of health insurance plans, including individual and family plans, Medicare plans, and employer-sponsored plans. The company also provides wellness programs and other health-related services to its members. IBC was founded in 1938 as the Associated Hospital Service of Philadelphia and changed its name to Independence Blue Cross in 1988.
Learn more about Independence Blue Cross
Size
8,500 employees
Industry
Healthcare
Founded
1938
* Ladders Estimates

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