Quality and Reporting Analyst

Health Care Service Corp.; United States; Remote; USD 48,000 - 86,000; Full time

Job summary

HCSC is seeking a detail-oriented professional to audit operations for regulatory compliance across assigned areas. The role ensures adherence to Plan, BCBSA, NCQA and state/federal requirements, researching trends and producing monthly summaries that illuminate impact on accreditation.

The candidate will gather and analyze data, prepare reports, and communicate findings to management while supporting cross-department projects and resolving issues with staff across teams.

Qualifications

• Bachelor degree and 2 years of insurance experience OR 6 years’ insurance experience.
• Knowledge of health care regulatory and legislative process; experience reading and interpreting legislation.
• Knowledge or experience reviewing accreditation standards and evaluating level of compliance, identifying challenges and proposing solutions.
• Knowledge or experience monitoring compliance and managing evidence documents.
• Experience preparing monthly reports and forecasting.
• Research skills.
• Analytical skills.
• Detail orientation and organizational skills; experience meeting deadlines on time.
• Clear and concise verbal and written communication skills.

Responsibilities

• Audit operations for regulatory compliance in assigned areas.
• Research and report monthly on trends and their impact on accreditation.
• Develop and implement technical solutions and communicate gaps to management.
• Gather data, analyze, and prepare reports from multiple sources and systems.
• Support projects and initiatives and resolve cross-department issues.

Skills

Analytical skills

Research skills

Detail orientation

Verbal and written communication

MS Word

MS Excel

MS Access

Cognos

Education

Bachelor degree

Tools

Word

Access

Excel

Cognos

Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

This position is responsible for auditing operations compliance with accreditation and regulatory requirements in assigned areas. Ensuring compliance with Plan, BCBSA, NCQA and State and Federal regulatory requirements. Researching and reporting monthly on trends. This will include monthly documented summaries, receipts, and how these impact accreditation requirements. Recommending and implementing technical solutions (i.e. Enterprise Appeals Application requirements) and communicating to the management team of the need/gap. Gathering data, analyzing data, and preparing reports including disseminating information from various sources and systems. Supporting projects and initiatives and resolving issues by working with staff within the department and across department.

Required Job Qualifications

• Bachelor degree and 2 years of insurance experience OR 6 years’ insurance experience.
• Knowledge of health care regulatory and legislative process; experience reading and interpreting legislation.
• Knowledge or experience reviewing accreditation standards and evaluating level of compliance, identifying challenges and proposing solutions.
• Knowledge or experience monitoring compliance and managing evidence documents.
• Experience preparing monthly reports and forecasting.
• Research skills.
• Analytical skills.
• Detail orientation and organizational skills; experience meeting deadlines on time.
• Ability and willingness to travel, including overnight stays.
• Clear and concise verbal and written communication skills.
• PC proficiency to include Word, Access, Excel and Cognos.

Preferred Job Qualifications

• Experience assisting with or leading projects.
• Highly preferred 1+ years' experience in ongoing audits, relating to but not limited to healthcare and provider data.
• Ability to confidently interact with senior leaders and executives.
• Audit tools experience (PPW, Salesforce, etc.).
• Knowledge of Accreditation (i.e. NCQA, URAC, CMS, etc.).
• Professional level of MS Suite skills (MS Office, Word, PowerPoint, Excel, etc.).

Compensation and Benefits

Sponsorship will not be provided for this role.

Base Pay Range $47,500.00 – $86,000.00. Exact compensation may vary based on skills, experience, and location. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii. This is a Telecommute (Remote) role.

Equal Opportunity Employment

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. We are a drug-free and smoke-free workplace. Employment may be contingent upon successful completion of drug screening in accordance with applicable law.

Accommodations

If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at 1-866-977-7378 to request reasonable accommodations. Please note that only requests for accommodations in the application process will be returned.