Independence Blue Cross · 1 week ago
Manager Compliance & QA
Philadelphia, Pennsylvania
Full-time
Onsite
Mid, Senior Level, Lead/Staff
8+ years expIndependence Blue Cross is seeking a Manager of Compliance & QA to oversee quality assurance programs across multiple operational functions. This role involves leading a team to drive continuous improvement and ensure alignment with enterprise quality standards and compliance expectations.
Health CareHealth InsuranceInsuranceMedical
Responsibilities
Oversee all quality-related operational activities across customer service, client setup, appeals, enrollment, billing, and other operational areas, ensuring timely issue identification, thorough audit documentation, comprehensive analysis, and clear communication of results to Operations and Compliance teams
Drive process optimization initiatives and maintain rigorous standards of quality and compliance throughout the organization
Assume accountability for operational transaction auditing in support of regulatory compliance audits and client Performance Guarantees (PGs) reporting
Actively manage daily workflow, productivity, and accuracy of quality analysts to ensure consistent performance against established expectations and standards
Collaborate with internal business partners to facilitate effective problem resolution, conduct root cause analyses, and advocate for high-quality operational performance, promptly addressing and resolving instances of substandard quality
Support internal, external customer, third-party, state, and federal audits by providing required data, validating reports, and submitting documentation in accordance with all relevant guidelines and specifications
Deliver operational performance metrics and trend analyses across daily, weekly, and monthly intervals, partnering with Operational Leaders, Compliance, and Internal Audit to enhance efficiency, strengthen accuracy, and drive sustained process improvements
Deliver operational performance metrics and conduct trend analyses to monitor key metrics on a daily, weekly, and monthly basis. Ensure regular engagement with Operational Leaders, Compliance, and Internal Audit to optimize efficiency, strengthen accuracy, and drive sustained process improvements
Provide strategic leadership in the professional development of direct reports by fostering engagement, recognition, and growth through effective coaching, performance guidance, and development planning to support individual and team success
Qualification
Required
Bachelor's degree in Business Administration, Information Systems, Computer Science, Data Analytics, or related field
Minimum of eight (8) years of relevant experience across various operational disciplines
Demonstrated expertise in quality assurance standards, including plan development, change control, and documentation practices
Extensive experience in administration of benefits and claims handling
Advanced analytical and technical proficiency in leveraging data analytics to investigate root causes of deficiencies and assess the effectiveness of controls
Proven ability to manage multiple projects within a dynamic development environment
Demonstrated proficiency in defining business solutions, making informed decisions, identifying and resolving problems, coordinating resources, and implementing organizational changes
Demonstrates strong attention to detail and a clear understanding of corporate objectives, with the ability to manage projects and implementations throughout their life cycle while consistently meeting established deadlines
Exceptional verbal and written communication skills
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
Funding
Current Stage
Late StageLeadership Team
Alexandra Jorgensen
Senior Vice President Human Resources
Joe Geist
SVP & Market President, National
Recent News
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2026-01-14
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