Healthrules Jobs in Pennsylvania (NOW HIRING)

Role: Quality Business Analyst
Description:
The Quality Business Analyst collaborates with various business areas to ensure compliance with established metrics, company policies, and procedures. Through auditing, the analyst identifies areas for improvement, system inconsistencies, and training opportunities that enhance operational excellence and support the delivery of high-quality service to clients and members.
Key Responsibilities:
Specific duties include, but are not limited to:

• Review operational activities end-to-end to ensure accuracy and completeness.

• Provide timely, documented feedback on issues identified at the processor and/or system level, and initiate escalation procedures when necessary.
• Collaborate with business areas to identify improvement opportunities and operational efficiencies.
Also responsible for:
• Audit operational transactions, including provider, member, and vendor communications, claims, appeals, grievances, enrollment, billing and client setup, to ensure accuracy and completeness.
• Review end-to-end operational activities to verify compliance with internal standards and regulatory requirements.
• Provide timely, documented feedback on issues identified at the processor and/or system level, and initiate escalation procedures when necessary.
• Identify process improvements and develop workflow and/or system recommendations to support operational efficiencies.
• Perform analysis to identify trends and detect root causes of deficiencies, supporting continuous improvement initiatives.
• Design and execute test plans for new or modified processes, ensuring changes function as intended and comply with applicable policies and regulations. Maintain detailed testing notes and documentation.
• Communicate effectively, both in writing and verbally, with internal and external teams.
• Support assigned projects, maintain documentation at the task level, monitor deadlines, and serve as a technical liaison when appropriate.
• Attend internal and external training to maintain proficiency on all systems and processes.
• Perform other duties as assigned.
Qualifications

• Minimum 3 to 5 years of quality review, auditing, or claims processing experience.

• Bachelor's degree preferred.

• Demonstrated self-starter with strong problem-solving, attention to detail, analytical, organizational, and writing skills.

• Knowledge of systems, process flows, and timelines to ensure requirements testing and implementation remain compliant across operational disciplines.
• Ability to compile detailed system requirements and use reporting and data mining to support business needs.
• Skilled in trend analysis and effective in communicating findings and recommendations to business partners, with a focus on minimizing impacts to other areas and customers.
• Superior written and verbal communication skills are required to provide business partners with information and tools that support system modifications and/or new implementations.
• Maintain flexibility in a team environment, identify process improvement opportunities, and define related system impacts.

• Working knowledge and experience with healthcare plans, Medicare regulations, claims processing, client setup, enrollment, and other operational areas.

• Foundational knowledge of systems, including Front Office System (FOS), HealthRules Payor (HRP), PRIME, Virtual Appeals Manager (VAM), Tableau, and ServiceNow (SNOW).

• Ability to effectively work autonomously in a hybrid environment.

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.