Business Analyst - BlueCard Operations

Overview

We are looking for a skilled Business Analyst to support the daily functions of BlueCard operations. This position plays a vital role in addressing operational issues, refining existing workflows, and aiding project management activities. Collaboration with team members and cross-functional groups like Configuration and Account Management is essential to resolve discrepancies and enhance the claims processing experience for BlueCard members.

Key Responsibilities

• Analyze claim issues and inquiries to assist the processing team; conduct root cause analyses and implement corrective actions for complete resolution.
• Coordinate with other plans to resolve member-related problems efficiently.
• Investigate causes of incorrectly processed claims, failed Direct Financed (DF) and Reimbursement Forms (RFs); offer solutions and work with appropriate parties to repair claims, educate processors or submit system enhancement tickets.
• Leverage technology including data analysis, bots, and various applications/tools to drive continuous improvements in claims processing.
• Disseminate knowledge and skills among team members to promote escalation opportunities for process improvements; schedule recurring meetings to maintain progress.
• Evaluate existing business processes and design, implement, test, and maintain technology solutions that improve cost efficiency or quality of processing.
• Support data extraction and assist in documenting processes and operating procedures.
• Act as a Subject Matter Expert representing the department in meetings, projects, and company-wide initiatives.
• Communicate with other plans utilizing the Blue Squared BCBSA application (RTM).
• Perform additional duties as assigned.

Required Qualifications and Skills

• A minimum of three years' experience in medical claims processing, claims adjusting, or healthcare administration.
• Proficient with the Blue Squared application.
• Technical knowledge of medical billing codes including ICD-10, CPT, HCPCS and claims processing systems.
• Strong proficiency in Microsoft Office suite, especially Excel, Word, and PowerPoint; preferred experience with SQL and Access.
• Familiarity with technologies, desktop tools, and operational processes is advantageous.
• Excellent analytical capabilities to examine claim data meticulously and identify inefficiencies or errors.
• Strong mathematical aptitude and capability to work independently under tight deadlines.
• Exceptional written and verbal communication skills to effectively engage stakeholders and expedite issue resolution.
• High attention to detail ensuring accuracy and thoroughness in reviewing claims.
• Must possess an Android or iOS device compatible with the Microsoft Authenticator app.

Additional Information

Independence Blue Cross is an equal opportunity employer. We welcome applicants regardless of age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability status.