Health Care Service Corporation
Quality and Reporting Analyst/Audit
Health Care Service Corporation, Chicago, Illinois, United States, 60290
At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.
Join HCSC and be part of a purpose-driven company that will invest in your professional development.
Overview
Job Summary This position is responsible for auditing operations compliance with accreditation and regulatory requirements in assigned areas. Ensuring compliance with Plan, BCBSA, NCQA and State and Federal requirements. Researching and reporting monthly on trends. This will include monthly documented summaries, receipts, and how these impact accreditation requirements. Recommending and implementing technical solutions (i.e. Enterprise Appeals Application requirements) and communicating to the management team of the need/gap. Gathering data, analyzing data, and preparing reports including disseminating information from various sources and systems. Supporting projects and initiatives and resolving issues by working with staff within the department or across departments. Responsibilities
Audits operations compliance with accreditation and regulatory requirements in assigned areas; ensures compliance with Plan, BCBSA, NCQA and State and Federal requirements. Researches and reports monthly on trends, including documented summaries, receipts, and the impact on accreditation requirements. Recommends and implements technical solutions and communicates gaps to management. Gathers, analyzes, and prepares reports from various sources and systems. Supports projects and initiatives and resolves issues by collaborating with staff across departments. Required Job Qualifications
Bachelor’s degree and 2 years of insurance experience OR 6 years’ insurance experience. Knowledge of health care regulatory and legislative process; experience reading and interpreting legislation. Knowledge or experience reviewing accreditation standards and evaluating level of compliance, identifying challenges and proposing solutions Knowledge or experience monitoring compliance and managing evidence documents. Experience preparing monthly reports and forecasting. Research and analytical skills. Detail orientation and organizational skills; experience meeting deadlines on time. Clear and concise verbal and written communication skills. PC proficiency to include Word, Access, Excel and Cognos. Preferred Job Qualifications
Audit experience and knowledge of Accreditation (i.e. NCQA, URAC, etc.) Knowledge and experience in advanced Microsoft data analytical skills Knowledge or experience in enterprise PDM business rules Knowledge or experience in NOSD internal systems (PPW, CAQH, Salesforce) Ability to handle multiple projects in an environment of urgent and shifting deadlines. Knowledge and experience in HCSC enterprise PDM business rules Knowledge and experience creating PowerPoint presentations Experience facilitating presentations and/or training materials Knowledge and experience with process/ system enhancements and continuous improvement Pay Transparency Statement: At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards . The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. HCSC Employment Statement: We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. Base Pay Range $40,900.00 - $91,000.00 Exact compensation may vary based on skills, experience, and location. For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities. HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants. If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at 1-866-977-7378 to request reasonable accommodations. Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "candidate home" to view your job submissions. Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association © Copyright 2025 Health Care Service Corporation. All Rights Reserved.
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Job Summary This position is responsible for auditing operations compliance with accreditation and regulatory requirements in assigned areas. Ensuring compliance with Plan, BCBSA, NCQA and State and Federal requirements. Researching and reporting monthly on trends. This will include monthly documented summaries, receipts, and how these impact accreditation requirements. Recommending and implementing technical solutions (i.e. Enterprise Appeals Application requirements) and communicating to the management team of the need/gap. Gathering data, analyzing data, and preparing reports including disseminating information from various sources and systems. Supporting projects and initiatives and resolving issues by working with staff within the department or across departments. Responsibilities
Audits operations compliance with accreditation and regulatory requirements in assigned areas; ensures compliance with Plan, BCBSA, NCQA and State and Federal requirements. Researches and reports monthly on trends, including documented summaries, receipts, and the impact on accreditation requirements. Recommends and implements technical solutions and communicates gaps to management. Gathers, analyzes, and prepares reports from various sources and systems. Supports projects and initiatives and resolves issues by collaborating with staff across departments. Required Job Qualifications
Bachelor’s degree and 2 years of insurance experience OR 6 years’ insurance experience. Knowledge of health care regulatory and legislative process; experience reading and interpreting legislation. Knowledge or experience reviewing accreditation standards and evaluating level of compliance, identifying challenges and proposing solutions Knowledge or experience monitoring compliance and managing evidence documents. Experience preparing monthly reports and forecasting. Research and analytical skills. Detail orientation and organizational skills; experience meeting deadlines on time. Clear and concise verbal and written communication skills. PC proficiency to include Word, Access, Excel and Cognos. Preferred Job Qualifications
Audit experience and knowledge of Accreditation (i.e. NCQA, URAC, etc.) Knowledge and experience in advanced Microsoft data analytical skills Knowledge or experience in enterprise PDM business rules Knowledge or experience in NOSD internal systems (PPW, CAQH, Salesforce) Ability to handle multiple projects in an environment of urgent and shifting deadlines. Knowledge and experience in HCSC enterprise PDM business rules Knowledge and experience creating PowerPoint presentations Experience facilitating presentations and/or training materials Knowledge and experience with process/ system enhancements and continuous improvement Pay Transparency Statement: At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards . The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. HCSC Employment Statement: We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. Base Pay Range $40,900.00 - $91,000.00 Exact compensation may vary based on skills, experience, and location. For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities. HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants. If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at 1-866-977-7378 to request reasonable accommodations. Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "candidate home" to view your job submissions. Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association © Copyright 2025 Health Care Service Corporation. All Rights Reserved.
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