What are the responsibilities and job description for the Client Setup Quality Analyst position at Independence Blue Cross Careers?
Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and well-being of the people and communities we serve.
Job Summary
· Responsible for auditing client and benefit setup.
· Validates Client Specific Benefits testing.
· Performs comprehensive group setup audits to identify processor accuracy and/or compliance issues to ensure quality setup for clients.
· Responsible for quality review of medical product/benefit accuracy, pharmacy, and other ancillary products.
· Analyzes error trend data and shares trends and opportunities with leadership.
· Supports testing and validation activities for all annual portfolio builds.
Responsibilities
· Conducts audits of client setup documents, including benefit templates. Responsible for client specific benefit template audits.
· Document audit findings, draft audit summaries and comprehensive audit reports and present to Sales
· Audits Account Installation new business groups for in accordance to the established Underwriting guidelines.
· Audits client benefit changes, administration changes and cancelations in accordance to the established Client Set Up 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.
· Handle errors and internal/external issues in a timely and effective manner to maintain turnaround times for completion 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.
Education
- Bachelor’s Degree preferred. In lieu of degree, must have 1-2 years relevant experience.
Experience
- Minimum 1-year relevant experience required; Audit experience preferred. Auditing, quality review or transaction processing experience required.
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 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 comply 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 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.
- 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.
IBX is an Equal Opportunity 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.