Appeals Specialist: Case Resolution & Compliance

Independence Blue Cross, LLC; Philadelphia (Philadelphia County); On-site; USD 60,000 - 80,000; Full time

Job summary

Independence Blue Cross, LLC is seeking an Appeals Specialist to conduct timely investigations of member and provider appeals and grievances. The role requires evaluating benefit plans, claims history, and supporting documentation to prepare complete case files for review.

You will communicate outcomes to stakeholders and maintain detailed records in our systems. The ideal candidate will have strong attention to detail, excellent written communication, and the ability to manage multiple cases

Qualifications

• Ability to research and analyze complex information from multiple systems.
• Experience handling appeals, grievances, or health insurance operations preferred.
• Excellent written and verbal communication with internal and external stakeholders.

Responsibilities

• Investigate member and provider appeals and grievances.
• Prepare case files for clinical or administrative review.
• Communicate case status and outcomes to stakeholders.
• Maintain accurate documentation in designated systems.
• Coordinate with internal departments and external partners to resolve cases.
• Ensure compliance with policies, contracts, and regulatory standards.

Skills

Attention to detail

Strong written communication

Time management

Independent work

Education

Associate degree or equivalent

Tools

Microsoft Word/Excel/Outlook

Job description

Independence Blue Cross, LLC is seeking an Appeals Specialist to conduct timely investigations of member and provider appeals and grievances. The role requires evaluating benefit plans, claims history, and supporting documentation to prepare complete case files for review.

You will communicate outcomes to stakeholders and maintain detailed records in our systems. The ideal candidate will have strong attention to detail, excellent written communication, and the ability to manage multiple cases