Claims Specialist
Independence Blue Cross
- Philadelphia, PA
- Permanent
- Full-time
- Responsible for accurate and timely handling of claim issues for all lines of business, including bi-directional sharing, FEP, Local and Commercial PA and AHNJ, BlueCard and Government market. Applies and maintains knowledge of claims processing and support systems.
- Research inquiries received from all areas, inclusive of internal and external sources (e.g. other plans, providers, legal, Sales); 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