BlueCross BlueShield of Western New York

About BlueCross BlueShield of Western New York


Job Category:



United States

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Approximate Salary:

Not Specified

Position Type:

Full Time

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Clinical Quality Assurance Analyst

Posted: 09/4/2018

Auto req ID 1691BR Company BlueCross BlueShield of WNY About Us BlueCross BlueShield of Western New York is a division of HealthNow New York Inc., one of New York’s leading health care companies that provides access to quality health care and solutions for members throughout Upstate New York. Since 1936, BlueCross BlueShield has helped millions of people gain access to health care. Headquartered in Buffalo, NY, the company is an independent Licensee of the BlueCross BlueShield Association. As the region’s leading health plan, serving over 800,000 members, BlueCross BlueShield believes in taking small steps towards healthier living. You can visit our website at Title Clinical Quality Assurance Analyst Position Posting Location Albany/Buffalo Status Full Time Regular Hours Asd required Job Description Under the general supervision of the Manager of Clinical Analytics, the Analytical Quality Assurance Analyst performs critical tasks needed for data distribution, analysis and improvement. Tasks range from report generation to complex troubleshooting when errors arise. The incumbent plays a pivotal role in producing, analyzing and reporting data for quality monitoring and improvement activities across the organization while evaluating problems to come up with novel solutions, identifying trends and/or breaks in patterns when evaluating data sets. The analyst takes initiative to understand critical angles of a problem independently and presents ideas to others, actively seeking out technology solutions across the spectrum of software available at HealthNow. Primary Responsibility - Conducts peer reviews on developed reports and data being analyzed
- Comprehends any processes, data, or methodologies used; completes testing, and uses source systems to validate numbers/measures/methods
- Develops dashboards that validate any data loaded into the various analytical tools (employer group reporting tool, risk tools, provider facing tools, provider portal, etc.)
- Identifies issues and notifies the correct constituents to resolve
- Reconciling the disparate data sources and assisting our EIM (Enterprise Information Management) and Information and Analytical Advancement (IA&A) department in governing data will be a critical focus for this role
- Ensures that other analysts understand the differences in each data source
- Collaborates with actuarial and finance to ensure that data and analytics provided by Healthcare Economics are consistent with the financial information provided to company executives
- Consistency and accuracy of executive level reporting is key to the success of the position
- Accountable for quality management of the process, supported by policies and systems, used by Healthcare Economics to maintain and enhance the quality of reporting and analytics
- Serves as the liaison between the Healthcare Economics team and our compliance and legal teams. They will assist in ensuring that regulatory policies are followed by all analysts and the data leaving the team has the appropriate deidentification applied
- Performs additional functions as required
Knowledge and Skills - Ability to understand and communicate regulatory and business requirements
- Knowledge of healthcare organizations, member enrollment, claims processing and member and claims data content
- Excellent organizational skills and attention to detail
- Ability to handle sensitive and proprietary information in a highly confidential manner
- Ability to communicate effectively with all levels of the organization
- Ability to manage multiple assignments simultaneously while maintaining quality standards and meeting assigned deadlines
- Ability to work in a fast-paced, collaborative environment
- Knowledge of Database Management Platforms, SQL, Analytical Tools (Cognos, SAS, Tableau, ArcGIS, SPSS), Predictive Modeling and Geospatial Analysis, and Microsoft tools (Excel, Access, Outlook).
Experience - Three (3) + years work experience in a Healthcare environment/health insurance industry required.
- Three (3) + years work experience in an analyst capacity required
Education Required Education:

- Bachelors Degree in Economics, Management Information Systems, Mathematics, or related area of study required
Working Conditions - Must be able to work in an office environment
- Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively use a computer with all its components for prolonged periods of time and for the majority of required tasks
- Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively utilize various office equipment (phone, computer, fax machine, printer, copier, filing cabinet, etc.)
- Mental effort: Adequate to perform essential functions of the job with the type of judgements and responsibilities as indicated in the job description
EEO Statement All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status. Removal Date 06-Feb-2019

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