3 Claims Specialist Jobs in Philadelphia, PA
Independence Blue Cross is Hiring a Claims Specialist Near Philadelphia, PA
- 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
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
Job Summary
Full Time
$61k-75k (estimate)
06/18/2024
07/01/2024
ibx.com
CEDAR GROVE, NJ
7,500 - 15,000
1938
DON MUZICH
$1B - $3B
Wholesale
Related Companies
About Independence Blue Cross
Independence Blue Cross is the leading health insurance organization in southeastern Pennsylvania. With our affiliates, we serve nearly 8.5 million people in 25 states and Washington, D.C., including more than 2.5 million in the region. For nearly 80 years, we have been enhancing the health and well-being of the people and communities we serve by delivering innovative and competitively priced health care products and services; pioneering new ways to reward doctors, hospitals, and other health care professionals for coordinated, quality care; and supporting programs and events that promote well...-being. To learn more visit www.ibx.com. Connect with us on Facebook and Twitter. Independence Blue Cross is a subsidiary of Independence Health Group, Inc. independent licensees of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.
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If you are interested in becoming a Claims Specialist, you need to understand the job requirements and the detailed related responsibilities. Of course, a good educational background and an applicable major will also help in job hunting. Below are some tips on how to become a Claims Specialist for your reference.
Step 1: Understand the job description and responsibilities of an Accountant.
Quotes from people on Claims Specialist job description and responsibilities
The specialist reports and processes these claims by researching the policy and accumulating evidence regarding the claim.
02/21/2022: Benton Harbor, MI
Claims specialists must also compile reports and communicate regularly with supervisors and managers regarding the status of claims.
03/17/2022: Madison, WI
Claims Specialists are responsible for a wide range of administrative tasks related to the delivery of medical care.
03/13/2022: New Brunswick, NJ
Evaluates liability, coverage and settles claims within prescribed procedures and authority.
03/07/2022: Vallejo, CA
Reviews and evaluates property claims for coverage and further claim handling procedures to conclude within required statutory time frame.
03/03/2022: Provo, UT
Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.
Career tips from people on Claims Specialist jobs
Claims specialists are required to follow the California Health and Safety Code when accepting or denying claims.
02/04/2022: Lynchburg, VA
They must treat clients fairly and equitably, but also make sure claims are legitimate and reasonable.
03/03/2022: Portland, ME
They must know the details of claims verification, payment processing, dispute resolution and fraud detection.
02/14/2022: Hialeah, FL
A good claims specialist will take a proactive approach to their job.
02/21/2022: Helena, MT
Claims specialist positions require superb organization skills to keep track of financial documents.
03/26/2022: New Bedford, MA
Step 3: View the best colleges and universities for Claims Specialist.
