Claims Specialist

Independence Blue Cross, LLC; Philadelphia (Philadelphia County); On-site; USD 42,000 - 62,000; Full time

Job summary

Independence Blue Cross, LLC is seeking a detail-oriented claims processor to handle Local and Commercial PA, AHNJ, and Government market issues with timely, accurate processing.

The role requires 1–3 years in production, strong math and communication skills, and proficient MS Office use (Excel/Word). You will research inquiries, adjust payments as needed, and meet quality targets in a collaborative environment.

Qualifications

• High School diploma or equivalent is required.
• 1–3 years of proven work experience in a production environment.
• Demonstrated math and comprehension skills are 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.
• Ability to research and investigate information using multiple sources and documented guidelines.
• Strong organizational skills and problem solving ability.
• Detail-oriented.

Responsibilities

• Handle claim issues timely and accurately for Local and Commercial PA, AHNJ, and Government market.
• Research inquiries from internal and external sources; adjust payable claim payments following guidelines.
• Meet departmental quality and production requirements.
• Respond professionally to inquiries while maintaining standards.
• Research paid claims to recover overpaid/underpaid dollars and process adjustments.
• Provide responses to general questions with updates and resolution dates for complex issues.
• Complete special projects and participate in work groups as assigned.
• Perform other duties as necessary.

Skills

Math

Interpersonal skills

Communication

Organizational skills

Attention to detail

Education

High School diploma or equivalent

Tools

Microsoft Office

Job description

Responsibilities

• 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.