Senior Quality Business Analyst
About the role
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.
Responsibilities
- 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
- Aid in 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.
- 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.
Requirements
- 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
Qualifications
Required:
- 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.
- 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.
Skills
Not specified
Benefits
Not specified
Pay
Not specified
Schedule
Not specified
Company Information
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.
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.