Senior Quality Business Analyst – FEP Claims Quality & Audit

IntePros is seeking an experienced Senior Quality Business Analyst to support Federal Employee Program (FEP) Claims operations and quality assurance initiatives. The role involves ensuring claims transactions are accurate and compliant, analyzing workflows for operational efficiency, and acting as a liaison between various teams to improve claims quality and customer outcomes.

Responsibilities:

• Review FEP claims transactions to ensure processing accuracy, system integrity, and compliance with established business rules and regulatory requirements
• Perform detailed quality audits and identify transaction-level or systemic discrepancies
• Provide timely, documented feedback regarding processor trends, audit findings, and system-related concerns
• Escalate issues appropriately and proactively recommend corrective actions
• Identify quality trends and root causes impacting operational performance
• Analyze existing FEP workflows and identify opportunities for operational efficiency and process enhancement
• Translate findings into workflow recommendations and system improvement initiatives
• Assess downstream business impacts of proposed process or system modifications
• Participate in cross-functional initiatives aimed at improving quality, accuracy, and customer experience
• Represent FEP Claims on projects and strategic initiatives
• Evaluate impacts, identify action items, and provide subject matter expertise throughout project lifecycles
• Support analysis activities including tracking, documentation, implementation planning, and issue resolution
• Act as a technical liaison between business and operational teams
• Assist in developing test strategies, plans, scenarios, and validation methodologies
• Execute and document testing for new or modified systems, workflows, and business processes
• Maintain detailed test cases, findings, outcomes, and recommendations
• Develop and maintain current user documentation and procedural materials
• Serve as a primary resource for FEP operational guidance and business process interpretation
• Communicate findings, recommendations, and project updates effectively to stakeholders across multiple levels
• Support departmental knowledge-sharing and cross-training initiatives
• Participate in educational opportunities to maintain expertise across systems and FEP changes

Requirements:

• 5–8+ years of related experience in healthcare claims operations, quality, or business analysis
• Direct experience with FEP Facility Claims processing and adjustments
• Hands-on experience with FEP Claims Quality Assurance and auditing
• Strong understanding of FEP process flows, claims regulations, and operational controls
• Experience performing trend analysis and translating findings into business recommendations
• Experience gathering, documenting, and validating business requirements
• Demonstrated experience supporting testing efforts and system implementations
• Strong written and verbal communication skills
• Ability to work independently while managing multiple initiatives
• Bachelor's degree or equivalent professional experience
• Experience supporting enterprise claims initiatives or system implementations
• Strong reporting and data analysis capabilities
• Experience with root cause analysis methodologies
• Exposure to UAT, workflow redesign, and process optimization initiatives
• Knowledge of healthcare payer environments and claims systems
• Experience serving as a liaison between business and technology teams