Senior Claims Analyst: Complex Adjustments & Reconciliations

Independence Blue Cross, LLC; Philadelphia (Philadelphia County); On-site; USD 65,000 - 85,000; Full time

Job summary

Independence Blue Cross, LLC seeks a FEP Senior Claims Specialist to ensure accurate, timely handling of FEP claim issues and provide expertise to support the team. Responsible for applying comprehensive knowledge of claims processing and support systems.

The role includes researching complex adjustments, timely reconsiderations, meeting quality targets, handling inquiries professionally, and assisting junior staff as needed.

Qualifications

• High School graduate or equivalent work experience.
• 3–5 proven work experience in a production environment.
• Proficiency with Microsoft Office, especially Excel and Word.

Responsibilities

• Research and adjust complex/high-dollar adjustment requests from internal and external sources.
• Handle FEP reconsiderations accurately and timely per manuals and guidelines.
• Meet departmental quality and production requirements.
• Respond professionally to inquiries while maintaining standards.
• Research and analyze complex claims; recover overpaid/underpaid dollars and process adjustments.
• Follow standard responses to inquiries and ensure consistency.
• Report trends of claim errors for corrective interventions.
• Assist junior staff as needed.

Skills

FEP claims knowledge

Excel proficiency

Communication skills

Research skills

Education

High School diploma

Tools

MS Office

Claims systems

Job description

Independence Blue Cross, LLC seeks a FEP Senior Claims Specialist to ensure accurate, timely handling of FEP claim issues and provide expertise to support the team. Responsible for applying comprehensive knowledge of claims processing and support systems.

The role includes researching complex adjustments, timely reconsiderations, meeting quality targets, handling inquiries professionally, and assisting junior staff as needed.