Client Setup Quality Analyst

Independence Blue Cross, LLC; Philadelphia (Philadelphia County); Hybrid; USD 65,000 - 85,000; Full time

Benefits offered by this job

Hybrid work model

Job summary

Independence Blue Cross, LLC is seeking an Audit Specialist to validate client benefit setup and ensure accuracy across medical, pharmacy, and ancillary products. You will review templates, document audit findings, and present results to Sales leadership.

The role involves auditing account installations, changes, and cancellations per underwriting guidelines, with a focus on timely issue resolution and process improvement.

Qualifications

• Auditing client setup and benefit templates.
• Document audit findings, summarize audits, and present to Sales.
• Audit new business groups for underwriting guidelines.

Responsibilities

• Audits client benefit changes and setup documentation for accuracy.
• Ensure product information, rates, and templates are correct before approval.
• Meet departmental production standards and document inventory.

Skills

Audit processes

Healthcare products

Project management

Independent work

Communication skills

Time management

Microsoft Office

Education

Bachelor's degree preferred

12 years relevant experience in lieu of degree

Tools

Microsoft Word/Excel/PowerPoint

Job description

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 wellbeing 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 setup.


• 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 12 years relevant experience.

Experience

• Minimum 1year 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.


• Indepth 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 fastpaced 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 problemsolver and be able to followup 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 TriState 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.