Sr Claims Specialist

Independence Blue Cross, LLC; 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

• 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.
• 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.
• 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.
• 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 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!