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Senior Client Setup Quality Assurance Specialist
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We are seeking a highly skilled Senior Client Setup Quality Assurance Specialist to join our team at Independence Blue Cross. As a key member of our organization, you will play a critical role in ensuring the accuracy and quality of client benefits and setup.
Key Responsibilities- Participate in pre- and post-implementation audits of client benefits and setup to ensure compliance with established guidelines.
- Prepare and conduct comprehensive group setup audits to validate setup accuracy and identify potential issues.
- Review claims and systems to ensure 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 and collaborating with client implementation, sales, and audit teams to understand scope and timeline for audits.
- 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, with demonstrated project management skills.
- Ability to work independently and effectively communicate with all levels of management and external clients.
- Flexibility and adaptability are essential, with a willingness to be cross-trained to assist other team members.
- Strong communication and time management skills, with the ability to prioritize workload and meet deadlines in a fast-paced environment.
- Knowledge of systems, process flows, regulatory impacts, and timelines to ensure compliance across operational disciplines.
- Skilled in trend analysis and effective communication of findings and recommendations to minimize impacts to other areas and the customer.
- Strong problem-solving skills, with the ability to follow up and take issues to resolution.
- Strong understanding of benefits and underwriting rating methodology, with the ability to apply Underwriting guidelines.
- Strong critical thinking skills and proficiency with HealthEdge applications (HealthRules) or other benefits/claims processing software.
