Quality Manager
Wellvana
Business Operations Analyst
Capital Blue Cross
full-time
Posted on:
Origin: • 🇺🇸 United States • Pennsylvania
Visit company websiteSalary
💰 $47,800 - $91,070 per year
Job Level
JuniorMid-Level
About the role
- Provide analytical, technical and problem resolution support to Health Plan Operations
- Conduct analysis and reporting, quality assurance, planning, controlling, directing and project activities
- Obtain necessary approvals on systems configuration, systems testing and application changes
- Create reports for Health Plan Operations; prepare materials for monthly KPI, meetings with CMS regional office, compile audit packages
- Research and problem solve for claims and enrollment functions; recommend changes to inquiry processing procedures
- Serve as team member on department/corporate projects and maintenance activities
- Perform claims processing in support of department performance goals
- Elicit and document requirements to support maintenance activities (i.e. PCA’s)
- Anticipate problems, seek solutions, and work with business areas to implement solutions; generate options to achieve long-range goals
- Support up to three subject matters as SME
- Build strong working relationships with internal and external customers; summarize analytical research and processes verbally and in writing
- Perform testing for projects and maintenance; execute test scenarios and evaluate defects
Requirements
- 2 years of experience working with integrated business systems that supports claims processing, membership, billing, network, clinical, customer service, and/or product processes
- Ability to analyze problems and issues, determine impact, and develop business solutions for system changes
- Ability to act as a liaison and recommend solutions to a variety of departments and external business partners
- Ability to plan, organize, and participate on projects
- Effective written and verbal communication with technical and non-technical audiences
- Persuasion and negotiation skills
- Ability to quantify and prioritize assigned activities, adapt to changing priorities, and perform duties with minimal supervision
- Ability to act independently and as part of a team
- Preferred knowledge of the health care industry and standards, policies, and business practices
- Knowledge of data processing terminology and concepts
- High level technical understanding of Microsoft Office Suite, Crystal Reporting and Data Modeling
- High School diploma or equivalent (Prefer a Bachelor's Degree in business administration, health planning and administration, information systems, computer science)
- May require minimal travel
