Claims Specialist

Independence Blue Cross; Philadelphia (Philadelphia County); On-site; USD 42,000 - 56,000; Full time

Job summary

Independence Blue Cross in Philadelphia is seeking a detail-oriented claims processor to handle Local, Commercial PA and AHNJ, and Government market claims. You will research inquiries from various sources, perform adjustments when needed, and ensure timely, accurate processing.

The role supports departmental standards, participates in projects, and provides updates on status and resolution dates for complex issues. Strong Excel/Word skills and attention to detail are essential.

Qualifications

• High School graduate or equivalent work experience.
• 1–3 years proven work experience in a production environment.
• Demonstrated math and comprehension skills.
• Proficiency with Microsoft Office, specifically Excel and Word.
• Strong organizational and problem solving ability.
• Detail-oriented.

Responsibilities

• Handle claim issues for Local, Commercial PA and AHNJ, and Government market timely and accurately.
• Research inquiries from internal and external sources and perform claim payment adjustments when appropriate following guidelines.
• Meet departmental quality and production requirements.
• Respond professionally to inquiries while maintaining standards.
• Research paid claims to recover overpayments/underpayments and process adjustments.
• Provide daily status updates and resolutions for complex issues.
• Complete special projects and participate in work groups as assigned.
• Perform other duties as necessary.

Skills

Math skills

Interpersonal skills

Communication skills

MS Office (Excel/Word)

Research ability

Organizational skills

Detail-oriented

Education

High School diploma

Tools

Microsoft Office Suite

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.
• 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

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.

Inclusion and Belonging

At IBX, everyone can feel valued, supported, and comfortable to be themselves, and all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. Celebrating and embracing diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

About Our Company

Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.

At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com . We’re revolutionizing health care, and our focus is on you!

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.