Senior Clinical Quality Analyst

This position is eligible for remote work within 2-3 hours of the Fargo, ND office.

All about us

You likely know us as an insurance company, but that's just a portion of what we do. Hundreds of thousands of North Dakotans trust us to provide them with personalized service and unmatched access to care. It's a mission we take seriously.

We also work with entities throughout the state to challenge the cost and complexity of health care in North Dakota. This uncompromising goal requires caring, innovative people who are ready and willing to help create a new level of health and well-being in North Dakota and beyond.

Work environment

This opportunity is eligible for a remote, hybrid or in-office work arrangement based out of our Fargo, ND office location. If remote, this position should be within 3 hours of driving distance of the Fargo office in order to attend trainings and occasional, planned travel to providers within North Dakota. We empower our employees to find a work style that is best for them. Learn more at Life at Blue | BCBSND.

This position is eligible for internal and external applications.

Pay Information

• Pay Level: 024
• FLSA Category: Exempt - Salaried
• Individual pay will be based on skills, experience, qualifications, location, internal equity, and other relevant factors.
• Opportunities for continued salary growth through a performance-based merit program.

A day in the life

The Senior Clinical Quality Analyst is responsible for collaborating with internal departments, external stakeholders, and community resources to enhance clinical quality and member experience. This role involves project planning, data analysis, and developing interventions to improve health plan ratings and value-based programs. The Senior Clinical Quality Analyst is responsible for continuously monitoring quality performance against benchmarks, making necessary adjustments, and supporting reporting and quality improvement plans. This role requires a proactive approach and detailed problem-solving skills that are crucial in driving improvements and achieving performance targets.

Your responsibilities will include

• Translates complex business needs into solid business and functional requirements within the clinical quality space.
• Identifies opportunities, contributes recommendations based on analysis of requirements and future impacts, and determines course of action.
• Leads work for assigned initiatives including business process change/improvement, testing, training, and communication.
• Proactively identifies, researches, and troubleshoots a variety of information, system and process issues impacting the overall business operations of the department, division, or company.
• Supports business initiatives through data analysis, identification of implementation barriers, and performing user acceptance testing of various systems.
• Functions as a subject matter expert across multiple applicable systems and/or reporting platforms.
• Facilitates meetings and collaborates between various internal departments and external business partners in a positive way to drive cross functional stakeholders to reach agreements and effective solutions.
• Prepares and develops reporting standards and dashboards for quality performance. Supports internal teams and external stakeholders by analyzing and summarizing information and trends.
• Analyzes and promotes business enhancement efforts with the goal of creating a positive impact on the customer experience and towards creating efficiencies.
• Actively involved in enhancement and implementation efforts to ensure the solution fits the needs of our customers both internally and externally.
• Performs work under minimal supervision. Handles complex issues and problems and refers only the most complex issues to higher-level staff.
• Coaches and mentors department staff and collaborates with leadership to support strategic goals within the team.

What you need to succeed

• A bachelor's degree in Business, Management, or healthcare related field.
• At least 5 years of experience in business operations, data analysis, business analysis within healthcare or previous clinical experience, clinical quality management, or healthcare accreditation.
• Ability to think analytically and have a level of technical skills and problem-solving aptitude in order to analyze data.
• Proficient in Microsoft Office, including Outlook, Excel, PowerPoint and Word.
• Project management skills to manage varying projects and timelines.
• Comfortable with presenting data and reporting to internal team and external stakeholders, such as our provider organizations.
• Good collaboration and communication skills with the ability to work independently and be a self-starter.

Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards

Benefits

• Affordable medical, dental and vision coverage accepted throughout the United States
• Employer funded Lifestyle Spending Accounts, Health Savings Accounts and Health Reimbursement Arrangements
• Employer-paid life and disability insurance
• 401(k) retirement plan with company match and immediate vesting
• Paid holidays, paid time off (PTO), PTO donation program, and paid parental leave
• Voluntary benefits including Accident, Hospital Indemnity, Critical Illness, Term/Whole Life, Cancer Care Insurance, and more.

Additional company perks

• Robust mental health offerings including an Employee Assistance Program, Learn to Live, meQ.
• Comprehensive learning and development opportunities and an Educational Assistance Program.
• 16 hours of paid volunteer time with a $200 donation to a charity of your choice upon completion of all volunteer hours.
• Employee recognition, community initiative events and yearly company outings.
• Workplace flexibility offering different options for working arrangements and the freedom to make time for important commitments.
• Opportunities to connect through employee committees.

Equal opportunity employment

Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity.

For questions, please email careers@bcbsnd.com

This job posting will be closed 1/31/2025 at 8:00 a.m. (CT). No further applications will be considered.