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Independence Blue Cross · 2 weeks ago

Senior Quality Business Analyst

Philadelphia, PA

Full-time

Hybrid

Senior Level

6+ years exp

Independence Blue Cross is seeking a Senior Quality Business Analyst who will be responsible for leading quality assurance initiatives across multiple business areas. This role involves performing advanced audits, trend analysis, and collaborating with various stakeholders to ensure compliance and optimize business processes.

Health CareHealth InsuranceInsuranceMedical

H1B Sponsor Likely

Responsibilities

Lead and execute comprehensive end-to-end reviews of operational activities, ensuring accuracy, completeness, and alignment with organizational objectives and regulatory standards

Oversee and conduct advanced audits of operational transactions (e.g., Enrollment, Billing, Claims, Appeals, Client Setup), identifying systemic risks, root causes of deficiencies, and opportunities for process and system enhancement

Conduct Audit-the-Auditor reviews to validate accuracy, consistency, and adherence to process, organizational, and regulatory requirements

Train internal team on new incoming work or updated processes to ensure team alignment and compliance with quality standards

Develop and implement robust quality control frameworks, metrics, and escalation procedures, ensuring that issues identified at both the processor and system levels are resolved efficiently and sustainably

Collaborate with business leaders and stakeholders to design, recommend, and drive the adoption of process improvements, workflow optimizations, and system enhancements that deliver measurable operational efficiencies

Perform complex data analysis to identify trends, forecast potential challenges, and inform strategic quality initiatives

Lead the design, execution, and documentation of test plans for new or modified processes, ensuring full compliance with internal policies and external regulations

Provide expert guidance and mentorship to analysts, fostering a culture of continuous improvement and professional development

Serve as a technical and business liaison between operational teams, technical teams, and external partners, translating business requirements into actionable solutions

Prepare and deliver executive-level reports, presentations, and recommendations to senior leadership and cross-functional teams

Support and/or lead strategic projects, ensuring milestones are met and quality deliverables are achieved

Stay abreast of industry trends, regulatory changes, and best practices through ongoing training and external engagement

Perform other leadership duties as assigned

Qualification

Quality assuranceProcess improvement methodologiesData analysisOperational systems knowledgeHealthcare plan operationsMentoring teamsReporting skillsCommunication skillsOrganizational skillsProblem-solving skills

Required

Minimum 6 years of progressive experience in quality review, auditing, claims processing, or related operational roles within healthcare or a comparable regulated industry

Demonstrated expertise in process improvement methodologies (e.g., Six Sigma, Lean) and proven ability to implement large-scale quality initiatives

Superior analytical, problem-solving, and organizational skills, with a strong attention to detail and the ability to manage multiple priorities

Exceptional written and verbal communication skills, with experience presenting to executive leadership and facilitating cross-functional collaboration

Proven ability to work autonomously in a hybrid or remote environment, demonstrating initiative, flexibility, and a commitment to team success

Experience leading and mentoring teams, with a track record of fostering a culture of quality and continuous improvement

In-depth knowledge of healthcare plan operations, claims processing, client setup, enrollment, and related business areas

Strong data mining, reporting, and documentation skills to support business decision-making

Ability to effectively work autonomously in a hybrid environment. Must be in the office 3 times per week (Tuesdays, Wednesdays, Thursdays)

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

Preferred

Bachelor's Degree preferred

Advanced knowledge of operational systems, process flows, and regulatory requirements; proficiency with Front Office System (FOS), Health Rules Payor (HRP), Tableau, and Service Now (SNOW) strongly preferred

Company

Independence Blue Cross

Glassdoor3.5

The leading health insurer in southeastern Pennsylvania. It is a sub-organization of Independence Blue Cross.

Founded in 1938

Philadelphia, Pennsylvania, USA

5001-10000 employees

https://www.ibx.com

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)