Claims Specialist

Independence Blue Cross, LLC in; Philadelphia (Philadelphia County); On-site; USD 42,000 - 54,000; Full time

Job summary

Independence Blue Cross is seeking a claims processor in Philadelphia to handle Local and Commercial PA and AHNJ claims accurately and timely, applying knowledge of processing guidelines.

Responsibilities include researching inquiries from internal/external sources, performing claim adjustments, meeting quality targets, and providing timely status updates.

Qualifications

• Demonstrated math and comprehension skills required.
• Good interpersonal skills for handling internal and external customers.
• Well-developed listening, verbal and written communication skills.
• Proficiency with Microsoft Office, specifically Excel and Word is required.
• Ability to research and investigate information using multiple sources, operating systems and documented guidelines.
• Must have strong organizational skills and problem solving ability.
• Must be detail-oriented

Responsibilities

• Responsible for accurate and timely handling of claim issues for Local and Commercial PA and AHNJ, and Government market.
• Research inquiries from internal and external sources; perform member or provider payable claim payment adjustments when appropriate following guidelines.
• Meet departmental quality and production requirements.
• Respond professionally to inquiries while maintaining standards.
• Research claims paid incorrectly; recover overpaid/underpaid claim dollars and process adjustments.
• Provide responses to general questions; provide daily feedback, status updates and targets for complex issues.
• Complete special projects and participate in work groups as assigned.
• Perform other duties as necessary

Skills

Interpersonal skills

Communication skills

Microsoft Office proficiency

Research and investigative skills

Detail-oriented

Education

High School diploma

Tools

Excel

Word

Job description

• Responsible for accurate and timely handling of claim issues for Local and Commercial PA and AHNJ, and Government market. Applies and maintains knowledge of claims processing and support systems.
• Research inquiries received from all areas, inclusive of internal and external sources (e.g. other plans, providers, legal, Sales); as required, perform member or provider payable claim payment adjustments when appropriate following the correct processing guidelines.
• Meet departmental quality and production requirements
• Respond professionally to internal and external inquiries, as appropriate, while maintaining corporate and departmental standards.
• Research claims that are paid incorrectly; recover overpaid and underpaid claim dollars from multiple sources and ensure all necessary transactional steps are taken to accurately process claim adjustments.
• Provide response to general questions within expected departmental standards of initial inquiry; provide daily feedback, status updates and targeted resolution dates for more complex issues.
• Complete special projects and participate in work groups as assigned.
• Perform other duties as necessary

Qualifications

Education

• High School graduate or equivalent work experience.

Experience

• 1 3 years proven work experience in a production environment.

Knowledge, Skills, Abilities

• Demonstrated math and comprehension skills required.
• Good interpersonal skills for handling internal and external customers.
• Welldeveloped listening, verbal and written communication skills.
• Proficiency with Microsoft Office, specifically Excel and Word is required.
• Ability to research and investigate information using multiple sources, operating systems and documented guidelines.
• Must have strong organizational skills and problem solving ability.
• Must be detailoriented

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.