Claims Specialist at Independence Blue Cross LLC in Philadelphia, Pennsylvania

Job Description:

Bring your drive for excellence, team orientation and customer commitment to Independence; help us renew and reimagine our business and shape the future of health care.  Our organization is looking to diversify, grow, innovate and serve, and we are looking for committed, empowered learning-oriented people to join our team.  If this describes you, we want to speak with you.

The Claims Specialist’s responsibilities include, but are not limited to:

• Responsible for accurate and timely handling of claim issues for all product lines including Inter-Plan Bluecard Claims.  Applies and maintains knowledge of claims processing and support systems. 


• Research inquiries received from all areas, inclusive of internal and external sources; 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

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.


• 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.


• Must have strong organizational skills and problem solving ability.


• Must be detail-oriented