Description

The Senior Quality Business Analyst is a strategic partner and subject-matter expert, responsible for leading quality assurance initiatives across multiple business areas. This role leverages extensive analytical, technical, and leadership expertise to ensure compliance with metrics, optimize business processes, and drive continuous improvement. By performing advanced audits, trend analysis, and cross-functional collaboration, the Senior Quality Business Analyst plays a pivotal role in delivering superior service to clients and members while mentoring team members and influencing organizational quality strategy.

Key Responsibilities

• Lead and execute comprehensive end-to-end reviews of operational activities, ensuring accuracy, completeness, and alignment with organizational objectives and regulatory standards.
• Oversee and conduct advanced audits of operational transactions (e.g., Enrollment, Billing, Claims, Appeals, Client Setup), identifying systemic risks, root causes of deficiencies, and opportunities for process and system enhancement.
• Conduct Audit-the-Auditor reviews to validate accuracy, consistency, and adherence to process, organizational, and regulatory requirements.
• Train internal team on new incoming work or updated processes to ensure team alignment and compliance with quality standards.
• Develop and implement robust quality control frameworks, metrics, and escalation procedures, ensuring that issues identified at both the processor and system levels are resolved efficiently and sustainably.
• Collaborate with business leaders and stakeholders to design, recommend, and drive the adoption of process improvements, workflow optimizations, and system enhancements that deliver measurable operational efficiencies.
• Perform complex data analysis to identify trends, forecast potential challenges, and inform strategic quality initiatives.
• Lead the design, execution, and documentation of test plans for new or modified processes, ensuring full compliance with internal policies and external regulations.
• Provide expert guidance and mentorship to analysts, fostering a culture of continuous improvement and professional development.
• Serve as a technical and business liaison between operational teams, technical teams, and external partners, translating business requirements into actionable solutions.
• Prepare and deliver executive-level reports, presentations, and recommendations to senior leadership and cross-functional teams.
• Support and/or lead strategic projects, ensuring milestones are met and quality deliverables are achieved.
• Stay abreast of industry trends, regulatory changes, and best practices through ongoing training and external engagement.
• Perform other leadership duties as assigned.

Requirements

• Bachelor's Degree preferred.
• Minimum 6 years of progressive experience in quality review, auditing, claims processing, or related operational roles within healthcare or a comparable regulated industry.
• Demonstrated expertise in process improvement methodologies (e.g., Six Sigma, Lean) and proven ability to implement large-scale quality initiatives.
• Superior analytical, problem-solving, and organizational skills, with a strong attention to detail and the ability to manage multiple priorities.
• Advanced knowledge of operational systems, process flows, and regulatory requirements; proficiency with Front Office System (FOS), Health Rules Payor (HRP), Tableau, and Service Now (SNOW) strongly preferred.
• Exceptional written and verbal communication skills, with experience presenting to executive leadership and facilitating cross-functional collaboration.
• Proven ability to work autonomously in a hybrid or remote environment, demonstrating initiative, flexibility, and a commitment to team success.
• Experience leading and mentoring teams, with a track record of fostering a culture of quality and continuous improvement.
• In-depth knowledge of healthcare plan operations, claims processing, client setup, enrollment, and related business areas.
• Strong data mining, reporting, and documentation skills to support business decision-making.
• Ability to effectively work autonomously in a hybrid environment. Must be in the office 3 times per week (Tuesdays, Wednesdays, Thursdays).

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.