Senior Claims Analyst - Complex Adjustments & Mentoring

Independence Blue Cross; Philadelphia (Philadelphia County); On-site; USD 52,000 - 78,000; Full time

Job summary

Independence Blue Cross in Philadelphia seeks a Claims Processor to ensure accurate and timely handling of claim issues for FEP. You will research and adjust high-dollar adjustments, manage reconsiderations per guidelines, and meet quality targets while supporting internal and external inquiries.

Candidate should demonstrate strong math, communication, and research skills, with proficiency in Excel and Word. The role requires attention to detail and collaboration with junior staff.

Qualifications

• Strong math and comprehension skills
• Excellent written and verbal communication
• Ability to research and investigate information using multiple sources

Responsibilities

• Handle accurate and timely processing of claim issues for FEP
• Research and adjust complex/high-dollar adjustment requests
• Manage FEP reconsiderations per manuals and guidelines
• Meet department quality and production requirements
• Respond professionally to inquiries
• Research and analyze complex claims paying issues and recover overpayments/underpayments
• Follow departmental response standards
• Report trends of claim errors for corrective actions
• Assist junior staff as needed

Skills

Analytical skills

Interpersonal skills

Verbal and written communication

Research and investigative ability

Detail-oriented

Problem solving

Organizational skills

Education

High School diploma or equivalent

Tools

Excel

Word

Job description

Independence Blue Cross in Philadelphia seeks a Claims Processor to ensure accurate and timely handling of claim issues for FEP. You will research and adjust high-dollar adjustments, manage reconsiderations per guidelines, and meet quality targets while supporting internal and external inquiries.

Candidate should demonstrate strong math, communication, and research skills, with proficiency in Excel and Word. The role requires attention to detail and collaboration with junior staff.