Benefits Validation Specialist
Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and well-being of the people and communities we serve.
Benefits Validation Specialist-
- Assess and review all benefit related tickets
- Serves as liaison with Highmark and all entry points for benefit related tickets identified and submitted by Customer Service, Sales, Member Appeals, Executive inquiries
- Review and identify appropriate documentation and rules to support accurate responses to tickets
- Handle Benefit Incidents for all lines of business and all market segments in PA and NJ as well as Medicare Advantage Plans.
- Sources used are several Highmark Applications including, OCWA, FLOW, ICIS, and INSINQ. Additionally, sources used are Product Configurator, HMK Automated Benefit Templates, IBC submitted templates, change controls previously submitted, Project Requirements or any other documentation that would alter benefit setup at HMK
- Utilize benefit knowledge and benefit related expertise to respond to customer audits being managed by the External Audit team
- Review and provide specific supporting detail and appropriate written responses that are deemed appropriate to share with key, critical, highly visible customers
- Facilitate discussions to ensure various departments are aligned in understanding of rules and benefit setup
- Bachelor’s degree or equivalent experience
- 3-5 years of related experience
- Proven effective communication and analytical skills required to convey complex ideas and concepts by management
- Must be detail oriented and understand corporate objectives
- Proficient skills with Microsoft office
- Must have strong emphasis to details
- Excellent written and verbal communication skills
- Ability to multitask
Independence has implemented a “Hybrid” model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the “Hybrid” model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.
Independence Blue Cross is an Equal Opportunity and Affirmative Action 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.
Diversity, Equity, and Inclusion
At AmeriHealth, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that 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. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the 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 AmeriHealth, 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!
Equal Employment Opportunity
AmeriHealth is an Equal Opportunity and Affirmative Action 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.
Agency Disclaimer
All resumes submitted directly to an AmeriHealth employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of AmeriHealth and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by AmeriHealth or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.