Sr. Client Setup Quality Analyst | Independence Blue Cross

Job title: Sr. Client Setup Quality Analyst

Company: Independence Blue Cross

Job description: Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals. If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole-person health.Sr. Client Setup Quality Analyst Job Summary:

• Participates in Pre and Post-Implementation audits of client benefits and setup.
• Prepares accurate and complete claims test scenarios.
• Performs comprehensive group setup audits to validate setup accuracy and/or compliance issues to ensure quality setup for clients.
• Responsible for reviewing claims and systems to validate benefit setup accuracy for Medical products including Ancillary Setup as required.
• Effectively document and review audit results to ensure benefits are compliant with set-up requirements and Client’s contracted benefits.
• Assist the Configuration team with building benefit plans.

Responsibilities

• Participate in internal and external audits.
• Work with Client implementation, Sales, and Audit teams to understand the scope and timeline to audit client benefits and setup.
• Identify setup issues, trends, and process improvement opportunities through audit findings. Collaborate with client setup team members, Sales, and Product Management on discrepancies and errors to be corrected.
• Conducts audits of client setup documents, including benefit templates. Responsible for client-specific benefit template audits.
• Effectively document and communicate audit findings, audit summaries, and comprehensive audit reports and present them to Audit and Sales.
• Audits client benefit changes, administration changes, and cancelations in accordance with the established Client Setup and Underwriting Guidelines.
• Must ensure necessary documentation is received, product information is accurate, and rates are confirmed before the group is approved or benefits changes are processed.
• Meet departmental production standards and quality requirements.
• Properly document and track assigned inventory.
• Respond to inquiries regarding departmental procedures/policies from Account Executives, Client Set up, Brokers, Enrollment and Billing.
• Triage and resolve issues related to group set-up and benefit changes.
• Handle errors and internal/external issues in a timely and effective manager to maintain turnaround times for completion o of customer/group set-up.
• Develop and maintain positive client relationships with internal and external customers and Account Executives.
• Participate in special projects regarding customer implementation and changes.
• Recommend process changes to increase departmental efficiency.
• Perform additional duties as assigned.

Qualifications:Education

• Bachelor’s Degree preferred. In lieu of degree, must have 5 years relevant experience.

Experience

• Minimum years relevant experience required; Benefits and Claims experience preferred. Auditing and quality review experience required.
• Experience with HealthRules Manager/Designer preferred.

Knowledge, Skills, Abilities

• Considerable knowledge of audit processes and requirements, including organization and storage of documentation. Well versed in best practice process and procedures.
• In-depth knowledge of healthcare products, benefits, and systems.
• Proven effectiveness in managing to project targets and deadlines. Demonstrated effective project management skills necessary.
• Must be able to work independently.
• Ability to audit client documents to ensure benefits and products are set up correctly.
• Flexibility and adaptability are a must.
• Willingness to be cross-trained is required to assist other team members.
• Strong communications skills required – position interacts with all levels of management and may communicate with external clients as well.
• Excellent time management and organizational skills are required. Ability to prioritize workload and meet deadlines in a fast-paced environment without supervision.
• Knowledge of systems, process flows, regulatory impacts, and timelines to ensure requirements and implementation are complying across operational disciplines.
• 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. Ability to review and analyze data to identify patterns of incorrect benefit setup and benefit application of the setup in accordance with sound audit methods and practices.
• Must be a strong problem-solver and be able to follow up and take an issue to resolution.
• Strong understanding of benefits and underwriting rating methodology. Capability to understand Underwriting guidelines and apply them.
• Strong critical thinking skills.
• Proficiency with HealthEdge applications (HealthRules) or some other benefits/claims processing software
• High-level technical aptitude required – ability to use Microsoft Office and to learn proprietary and vendor systems. Demonstrated experience with Microsoft products (Word, Excel and Power Point.)

Independence has implemented a “Hybrid” model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the “Hybrid” model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app..Diversity, Equity, and InclusionAt Independence, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that 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. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the 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.About Our CompanyServing 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.At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at . We’re revolutionizing health care, and our focus is on you!Equal Employment OpportunityIndependence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.Agency DisclaimerAll resumes submitted directly to an Independence Blue Cross employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of Independence Blue Cross and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.

Expected salary:

Location: Philadelphia, PA

Job date: Sun, 11 Aug 2024 00:30:58 GMT

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