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Senior Client Setup Quality Assurance Specialist
2 months ago
We are seeking a highly skilled and detail-oriented Senior Client Setup Quality Analyst to join our team. As a key member of our organization, you will play a critical role in ensuring the accuracy and quality of client benefits setup.
Key Responsibilities- Participate in pre- and post-implementation audits of client benefits and setup to ensure compliance with established guidelines.
- Prepare accurate and complete claims test scenarios to validate benefit setup accuracy.
- Perform comprehensive group setup audits to identify and resolve setup issues and ensure quality setup for clients.
- Review 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 setup requirements and client-contracted benefits.
- Assist the Configuration team with building benefit plans.
- Bachelor's degree preferred; in lieu of degree, 5 years of relevant experience required.
- Minimum 5 years of experience in benefits and claims, with auditing and quality review experience required.
- Experience with HealthRules Manager/Designer preferred.
- Considerable knowledge of audit processes and requirements, including organization and storage of documentation.
- In-depth knowledge of healthcare products, benefits, and systems.
- Proven effectiveness in managing to project targets and deadlines.
- Ability to work independently and as part of a team.
- Strong communication and problem-solving skills.
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.
This role is designated as a hybrid model, with associates working in the office 3 days a week and remotely 2 days a week. The work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.
