Talent.com
Business Sys. QA Analyst

Business Sys. QA Analyst

EmblemHealthNew York, NY, United States
job_description.job_card.variable_days_ago
serp_jobs.job_preview.job_type
  • serp_jobs.job_card.full_time
job_description.job_card.job_description

Summary of Position

  • Proactively assess and monitor vendor Provider File Operations performance to achieve contractual targets on a daily basis.
  • Frequently interface with Provider Operations Tower Leaders to continuously identify and communicate opportunities for

improvement within Provider File Operations and business partner (claims, customer service, benefit set-up, enrollment,

and medical and pharmacy) core processes.

  • Identify areas of improvements in Provider File Operations, provide appropriate action plans, develop and implement
  • Vendor Operations performance analysis programs and metrics to improve operational efficiency.
  • Enhance brand and customer experience by identifying opportunities for improvement and variation trends via proactive
  • assessment.

    Principal Accountabilities

  • Create and execute test cases to deliver optimal system functionality and ensures that changes meet business and
  • quality requirements.

  • Report program incident trends; provide recommendations to resolve identified gaps in processes or protocols; work
  • with the teams to create corrective action plans and provide oversight for implementation and impact assessment.

  • Participate in the development and implementation of efficient and effective QA methodology, including test
  • automation, processes, procedures, templates, guidelines, and tools.

  • Conduct assessments and evaluate strategies to elevate overall quality and performance, as necessary.
  • Monitor and support programs on the utilization of best practices based on data collection and insight from various
  • QA / QI standards, in partnership with the City, State, Federal, or other regulatory bodies

  • Plan, execute, and provide oversight of multiple and simultaneous team-based projects along with other individually
  • assigned projects, including providing support in developing and expanding the scope of the company's corporate

    dashboards and other management reports for distribution to middle and upper management.

  • Organize and maintain report methodology documentation.
  • Continuously develop more efficient ways to produce reports; conceptualize approaches; advance skills of staff.
  • Develop visual platforms to share data, best practice highlights, and other information pertaining to program QA.
  • Communicate and collaborate with other Vendor Operations Management stakeholders as needed to support
  • overall EmblemHealth quality and customer experience objectives. Feed opportunities to your respective Vendor

  • Operations Tower Leaders on a real time basis to ensure proper and timely escalation to accountable parties.
  • Regular attendance is an essential function of the job. Perform other duties as assigned or required
  • Qualifications

    Education, Training, Licenses, Certifications

  • Bachelor's Degree, preferably in a quantitative analysis or related field.
  • Lean Six Sigma or Green Belt certification preferred.
  • Relevant Work Experience, Knowledge, Skills, and Abilities

  • 3 - 5+ years of relevant, professional work experience.
  • 2+ years' QA analysis experience, preferably in healthcare.
  • Clear understanding of the purpose, design, construction and maintenance regarding system configuration and accuracy.
  • Proficient with MS Office tools, SQL (Oracle or SQL Server); experience working with large volumes of data.
  • Knowledge of CPT / ICD 9 & 10 Codes, Diagnosis Codes, Revenue Codes.
  • Business Intelligence Experience (Cognos or Tableau).
  • Energy, drive and passion for End-to-End excellence and customer experience improvement.
  • Excellent collaboration skills and the ability to influence management decisions.
  • Strong problem solving and analytical skills that can be applied across all types of business problems.
  • Excellent communication skills (verbal, written, interpersonal, presentation, collaboration, facilitation).
  • Solid coaching skills to continuously develop staff core data analysis competencies at vendors.
  • Strong exposure to formalized testing strategy and detailed auditing principles and techniques.
  • Additional Information

    Requisition ID : 1000002641

    Hiring Range : $56,160-$99,360

    serp_jobs.job_alerts.create_a_job

    Qa Analyst • New York, NY, United States