Business Analyst AHA

Role overview

Independence Blue Cross is looking for an experienced Business Analyst to help support BlueCard day-to-day operations. The role is focused on resolving operational issues, improving existing workflows, and contributing to project management efforts. You will partner with internal teams and cross-functional groups, including Configuration and Account Management, to address claim discrepancies and strengthen the claims experience for BlueCard members.

What you will do

• Assist the processing team by reviewing claim-related issues and inquiries, then using root-cause analysis to identify what caused the problem and drive it to closure.
• Coordinate with other health plans to work through member issues and reach resolution.
• Investigate incorrectly processed claims, failed DF and RF cases, and similar exceptions. Recommend fixes, work with the right team members to correct the claim, and either retrain the processor or raise a ticket for a system enhancement.
• Use data, bots, and digital tools to identify and support ongoing improvements in claims processing.
• Share process-improvement ideas and technical knowledge with teammates, and help build a team culture that encourages escalation of improvement opportunities. Organize recurring meetings to maintain progress.
• Assess existing business processes and help design, implement, test, and maintain technology solutions that improve cost efficiency and quality.
• Support data gathering and help document procedures and work instructions.
• Act as a subject matter expert for department meetings, projects, and broader company initiatives.
• Communicate with other plans through the Blue Squared BCBSA application (RTM).
• Carry out additional duties as assigned.

Required experience and capabilities

• At least 3 years of experience in medical claims processing and adjustment, or in healthcare administration, with hands-on expertise in the Blue Squared application.
• Strong working knowledge of medical billing standards and codes such as ICD-10, CPT, and HCPCS, along with familiarity with claims processing software and the BlueCard product.
• Ability to analyze large datasets, compare information in multiple ways, and summarize findings clearly.
• Advanced Microsoft Office skills, especially in Excel, Word, and PowerPoint. Working knowledge of SQL and Access is preferred.
• Comfort using technology, desktop tools, and operations-related systems and processes.
• Strong analytical ability, including the capacity to identify errors, inefficiencies, and process gaps in claim data.
• Solid mathematical aptitude and the ability to work independently under tight deadlines.
• Excellent written and verbal communication skills for collaborating with stakeholders and resolving issues quickly.
• High attention to detail and a thorough approach to claim review.

Additional information

Independence Blue Cross is an equal opportunity employer. All qualified candidates will be considered without regard to age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

Applicants must have an Android or iOS device that can run the free Microsoft Authenticator app.