Business Analyst AHA

Independence Blue Cross; Philadelphia (Philadelphia County); On-site; USD 70,000 - 95,000; Full time

Job summary

Independence Blue Cross in Philadelphia seeks a Business Analyst to support claim operations with process improvements and system enhancements across claims administration, benefits, provider data, and provider services.

The role gathers requirements, analyzes data, and collaborates with operations, technology, and vendor teams to drive improvements and ensure accurate documentation and compliance throughout project lifecycles.

Qualifications

• Bachelor's degree in business administration, healthcare administration, or a related field.
• Two or more years of experience in business analysis, process improvement, or a related role within a health plan, third-party administrator, or healthcare payer environment.
• Experience and working knowledge of health plan workflows, such as claims processing, benefit administration, or provider data management.
• Strong analytical and problem-solving skills, including the ability to interpret healthcare administrative data, reconcile discrepancies, identify root causes, and evaluate solutions.
• Proficiency with Microsoft Excel, Word, and PowerPoint, SQL and Tableau and familiarity with process-mapping and collaboration tools.
• Strong written and verbal communication, meeting facilitation, and stakeholder collaboration skills.
• Ability to manage competing priorities, meet deadlines, work independently, and maintain accurate documentation.

Responsibilities

• Gather, analyze, validate, and document business requirements for claims, benefits, provider data, and member and provider inquiry processes.
• Evaluate current workflows, investigate processing errors, payment discrepancies, manual activities, and service issues, and recommend improvements based on root-cause analysis.
• Analyze claims, benefits, provider, and service data to identify trends, reconcile discrepancies, and report on accuracy, turnaround times, work inventory, and other operational measures.
• Partner with operations, technology, provider network teams, and vendors to clarify requirements, assess downstream impacts, and coordinate system and process changes.
• Maintain traceability among business needs, approved requirements, business rules, and test results, including changes related to provider contracts, and compliance guidance.
• Experience with core health plan administration platforms, electronic data interchange (EDI), provider reimbursement methodologies, or commercial, Medicare, or Medicaid products.
• Support implementation through procedure updates, and post-implementation validation of operational results.
• Track assigned deliverables, communicate progress, and elevate risks, issues, and dependencies promptly.

Skills

Excel

Word

PowerPoint

SQL

Tableau

Process mapping

Collaboration tools

Communication

Education

Bachelor's degree in business administration/healthcare administration or related field

Tools

EDI

Core health plan platforms

Job description

The Business Analyst supports claim operations with process improvements and system enhancements across claims administration, benefits, provider data, and provider services. From discovery through implementation and validation, the Business Analyst helps improve processing accuracy, operational efficiency, and the member and provider experience.

Key Responsibilities

• Gather, analyze, validate, and document business requirements for claims, benefits, provider data, and member and provider inquiry processes.
• Evaluate current workflows, investigate processing errors, payment discrepancies, manual activities, and service issues, and recommend improvements based on root-cause analysis.
• Analyze claims, benefits, provider, and service data to identify trends, reconcile discrepancies, and report on accuracy, turnaround times, work inventory, and other operational measures.
• Partner with operations, technology, provider network teams, and vendors to clarify requirements, assess downstream impacts, and coordinate system and process changes.
• Maintain traceability among business needs, approved requirements, business rules, and test results, including changes related to provider contracts, and compliance guidance.
• Experience with core health plan administration platforms, electronic data interchange (EDI), provider reimbursement methodologies, or commercial, Medicare, or Medicaid products.
• Support implementation through procedure updates, and post-implementation validation of operational results.
• Track assigned deliverables, communicate progress, and elevate risks, issues, and dependencies promptly.

Qualifications

• Bachelor’s degree in business administration, healthcare administration, or a related field, or an equivalent combination of relevant education and experience.
• Two or more years of experience in business analysis, process improvement, or a related role within a health plan, third-party administrator, or healthcare payer environment.
• Experience and working knowledge of health plan workflows, such as claims processing,benefit administration, or provider data management.
• Strong analytical and problem-solving skills, including the ability to interpret healthcare administrative data, reconcile discrepancies, identify root causes, and evaluate solutions.
• Proficiency with Microsoft Excel, Word, and PowerPoint, SQL and Tableau and familiarity with process-mapping and collaboration tools.
• Strong written and verbal communication, meeting facilitation, and stakeholder collaboration skills.
• Ability to manage competing priorities, meet deadlines, work independently, and maintain accurate documentation.

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.

Agency Disclaimer

All resumes submitted directly to anIndependence Blue Cross employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of Independence Blue Cross andthe Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.