Sr Claims Specialist

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

FEP Senior Claims Specialist

Responsible for accurate and timely handling of claim issues for FEP. Applies and maintains comprehensive knowledge of claims processing and support systems. Provides expertise and shares knowledge to support other team members.

Responsibilities

• Research and adjust complex and/or high dollar adjustment requests received from all areas, inclusive of internal and external sources (e.g. other plans, providers, FEP Directors Office);


• Handle FEP reconsiderations accurately and timely per the FEP benefit manuals and guidelines


• Meet departmental quality and production requirements.


• Respond professionally to external/internal inquiries, as appropriate, while maintaining corporate and departmental standards.


• Research and analyze complex claims that are paid incorrectly; recover overpaid and underpaid claim dollars and ensure all necessary transactional steps are taken to accurately process claim adjustments.


• Follow departmental standard for responses to all inquiries, and ensure the standard is achieved.


• Report observed trends of continuous claim errors/problems for corrective interventions.


• Assist junior staff as needed.

Qualifications

Education

High School graduate or equivalent work experience.

Experience

3 5 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.


• Knowledge of claims processing systems (membership, provider, adjustments)


• Experience working with providers and members preferred


• Ability to accurately perform research analysis, determine root cause and determine appropriate action


• Must have strong organizational skills and problemsolving 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.