Blue Cross and Blue Shield Association logo

Business Analyst

Blue Cross and Blue Shield Association

  • Philadelphia, PA
  • 5 days ago

    Highlights

    The Business Analyst supports vendor performance management for Appeals operations by analyzing performance data, identifying root causes of quality and compliance gaps, and supporting governance routines. This role partners with internal teams and vendor partners to improve appeals accuracy, turnaround time, and overall service performance while ensuring adherence to regulatory and contractual requirements.

    Numbers & Facts

    LocationPhiladelphia, PA
    IndustryInsurance
    Company Size2,000 to 2,499 employees
    Websitehttps://www.bcbs.com/about-us/careers

    Description

    The Business Analyst supports vendor performance management for Appeals operations by analyzing performance data, identifying root causes of quality and compliance gaps, and supporting governance routines. This role partners with internal teams and vendor partners to improve appeals accuracy, turnaround time, and overall service performance while ensuring adherence to regulatory and contractual requirements.

    Primary Responsibilities

    • Assist Vendor Onboarding and Offboarding activities through the contract lifecycle
    • Analyze Appeals performance (TAT, quality, overturn rate, inventory, productivity) to identify trends and risks
    • Monitor appeals inventory and case aging to support timely and compliant processing
    • Conduct root cause analysis on quality defects, overturns, and documentation gaps
    • Support vendor oversight, including SLA monitoring and issue resolution tracking
    • Develop reporting and executive-ready summaries for leadership and business reviews
    • Support Monthly Business Reviews and vendor governance routines
    • Identify and support process improvements to enhance accuracy, efficiency, and compliance
    • Partner with Operations, QA, Compliance, and vendor teams to drive performance outcomes

    Minimum Qualifications

    • Bachelor's degree in Business, Healthcare Administration, or related field
    • 2-5 years of experience in business analysis, operations, or healthcare environment
    • Strong analytical skills and experience working with performance metrics
    • Advanced Excel skills and experience developing reports
    • Strong written and verbal communication skills
    • Proven problem-solving and root cause analysis experience

    Preferred Qualifications

    • Experience in healthcare appeals or grievance operations
    • Familiarity with compliance/regulatory requirements (e.g., CMS, NCQA)
    • Experience supporting vendor/offshore operations or BPO environments
    • Knowledge of performance metrics (TAT, overturn rate, quality, inventory)
    • Experience with reporting tools (Power BI, Tableau, SQL)
    • Knowledge of process improvement methodologies (Lean, Six Sigma)

    Independence has implemented a "Hybrid" model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the "Hybrid" model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.

    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.

    About Company

    At the Blue Cross and Blue Shield Association (BCBSA), we provide business strategy, technical support and consulting expertise to 36 Blue Cross and Blue Shield companies across the nation, employing more than 1,000 of the best strategic thinkers in the industry. We are a Brand manager that sets quality control standards for the 36 independent companies that use the Blue Cross and Blue Shield Brands, and we serve as a trade association that represents these Blue companies. It is through our involvement that the Blues companies share a united vision and strategy while also benefiting from the local strength of all member companies.

    Similar Jobs

    See more jobs