Company Statement
EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.
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Business Sys. QA Analyst
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.
Security Disclosure
If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.
Pay Disclosure
At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.
EEOC Statement
We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.
Sponsorship Statement
At EmblemHealth, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, visa sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.