Independence Blue Cross · 1 month ago
Quality Business Analyst
Philadelphia, PA
Full-time
Onsite
Mid Level
3+ years expIndependence Blue Cross is seeking a Quality Business Analyst who will work collaboratively with various business areas to ensure compliance with established metrics and adherence to company policies and procedures. The analyst will identify areas for improvement, system inconsistencies, and training opportunities to enhance operational excellence, ultimately supporting the delivery of high-quality service to clients and members.
Health CareHealth InsuranceInsuranceMedical
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 operational transactions, including Enrollment, Billing, Claims, Appeals and Client Setup, ensuring 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 for 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 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
Qualification
Required
Minimum 3 to 5 years of quality review, auditing, or claims processing experience
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 and identify process improvement opportunities and define system impacts that may result
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), Health Rules Payor (HRP), Tableau and Service Now (SNOW)
Ability to effectively work autonomously in a hybrid environment
Preferred
Bachelor's Degree preferred
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app
Company
Independence Blue Cross
The leading health insurer in southeastern Pennsylvania. It is a sub-organization of Independence Blue Cross.
5001-10000 employees
H1B Sponsorship
Independence Blue Cross has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (16)
2024 (2)
2023 (6)
2022 (2)
2021 (6)
2020 (1)
Funding
Current Stage
Late StageLeadership Team
Alexandra Jorgensen
Senior Vice President Human Resources
Joe Geist
SVP & Market President, National
Recent News
Home Health Care News
2026-01-14
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