Business Analyst AHA

Independence Blue Cross; Philadelphia (Philadelphia County); On-site; USD 65,000 - 90,000; Full time

Job summary

Independence Blue Cross is seeking a Business Analyst to support BlueCard daily operations, resolving claims processing challenges and improving current processes. You will work with cross-functional teams to move issues toward resolution and support project initiatives.

The role emphasizes data-driven analysis, root-cause investigation, and the use of technologies and tools to enhance efficiency and accuracy in processing claims for BlueCard members.

Qualifications

• 3+ years in medical claims processing or healthcare administration.
• Experience with Blue Squared application and claims data analysis.
• Knowledge of ICD-10, CPT, HCPCS coding.

Responsibilities

• Analyze claim issues, perform root cause analysis and drive full resolution.
• Collaborate with cross-functional teams to resolve discrepancies and improve BlueCard processing.
• Research root causes of misprocessed claims, provide solutions, and coordinate repairs.
• Leverage data, bots, and tools to continuously improve claims processing.
• Share knowledge, schedule recurring meetings, and maintain momentum.
• Evaluate and implement process improvements for cost or quality gains.
• Assist with data extraction and documentation of processes and procedures.
• Represent the department as SME in meetings and projects.
• Communicate with other plans via the RTM platform.

Skills

Analytical skills

Attention to detail

Communication skills

Tools

SQL

Access

Blue Squared RTM

Job description

Seeking strong Business Analyst to support BlueCard daily operations. This support will assist to move forward resolution of operational challenges, improve current processes and support project management initiatives. You will work closely with other team members and cross functional teams such as configuration and Account Management to resolve discrepancies and improve claims processing experience for BlueCard members

Support the processing team with analysis of claim issues and inquiries. Perform root cause analysis and course correct identified issues for full resolution.

Work with other plans to resolve issues for members

Research root cause of incorrectly processed claims, failed DF and RFs. Provide solution and coordinate with appropriate team members to repair the claim and provide re-education to the processor or submit ticket for system enhancement.

Focus on applying technologies to continuously increase claims process improvements with the use of data, Bots and applications/tools.

Share this knowledge and skill with other team members to instill across the team the opportunities that they can elevate to process improve. Schedule reoccurring meetings to keep momentum.

Responsible for evaluating current business processes and developing, implementing, testing and maintaining Technology for more cost effective or quality improvement processing.

Assist with pulling needed data and assist with the documentation ofprocessesand work procedures.

Represent Department as SME in meetings, projects and company initiatives

Communicate with other plans via the Blue Squared BCBSA Application (RTM)

• Advanced skills in Microsoft Office and with Microsoft platforms (e.g. Excel, Word, PowerPoint) is required; working experience with SQL and Access preferred. Experience with technologies, desktop tools and or Operations processes and technology is helpful
• Perform other duties as assigned.

Experience: 3 years or more of experience in medical claims processing and adjusting or healthcare administration. Expertise in the Blue Squared application

Technical Skills:Knowledge of medical billing codes (ICD-10, CPT, HCPCS), claims processing software, and a strong understanding of the BlueCard product. Ability to summarize large amounts of data and pivot data in multiple ways

Analytical Skills:Ability to assess claim data in detail and identify errors or inefficiencies. Possess excellent mathematical skills and have the ability to work independently and within tight timeframes.

Communication Skills:Strong written and verbal communication skills for interacting with various stakeholders and resolving issues quickly

Attention to Detail:High level of accuracy and thoroughness in reviewing claims for clients

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.

Inclusion and Belonging

At IBX, everyone can feel valued, supported, and comfortable to be themselves, and 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. Celebrating and embracing 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 Company

Serving 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 www.ibx.com. We’re revolutionizing health care, and our focus is on you!

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.