Inter-Plan Relationship Coordinator
· Resolves common, complex and escalated issues directly impacting IBX Out-of-Area (HOST) provider claims by working with other BCBS Health Care Plans or directly with internal business teams. · Tracks issues, provides root cause analysis and escalates to Management enabling issues to be addressed at a National level. · Partners with all areas of company, especially the various IBX provider teams to achieve timely issue resolution and compliance with other BCBS Health Care Plans’ benefits requirements. · Takes ownership of resolving a partner plan inquiry from start to completion, including when an issue requires assistance of another internal area. · Acts as a liaison between IBX and all partner BCBS Health Care Plans to ensure end to end resolution of issues for all claims in accordance with the Inter-Plan Program (IPP) requirements. · Identifies and aids in establishing business requirements for system updates/changes to eliminate “operational” issues that are identified as trends/patterns of untimely, inaccurate, non-compliant or inconsistent claims adjudication for our participating providers or partner BCBS Health Care Plans involving multiple system and inquiry platforms. · Collects information related to issues and provides recommendations for educational material for the IBX provider community, especially where it concerns Host claims policies and processing. · Able to effectively use Internal reporting tools to manage, analyze, and perform trend analysis of open and closed inventory both onsite and offsite to meet stringent BCBS Association requirements. · Receives tracks and research Director level and above escalations for timely resolution in accordance with BCBSA escalation guidelines. · Demonstrated leadership, information driven decision-making, problem solving, organization and planning skills are essential to be successful in this position. · Effective presentation and communication skills, both oral and written are essential. · Ability to interact effectively with Providers/Partner Plan Staff at all levels and IBX associates at all levels, and across all departments. · Must be able to work efficiently in a team environment as well as individually. |
· Resolves common, complex and escalated issues directly impacting IBX Out-of-Area (HOST) provider claims by working with other BCBS Health Care Plans or directly with internal business teams. · Tracks issues, provides root cause analysis and escalates to Management enabling issues to be addressed at a National level. · Partners with all areas of company, especially the various IBX provider teams to achieve timely issue resolution and compliance with other BCBS Health Care Plans’ benefits requirements. · Takes ownership of resolving a partner plan inquiry from start to completion, including when an issue requires assistance of another internal area. · Acts as a liaison between IBX and all partner BCBS Health Care Plans to ensure end to end resolution of issues for all claims in accordance with the Inter-Plan Program (IPP) requirements. · Identifies and aids in establishing business requirements for system updates/changes to eliminate “operational” issues that are identified as trends/patterns of untimely, inaccurate, non-compliant or inconsistent claims adjudication for our participating providers or partner BCBS Health Care Plans involving multiple system and inquiry platforms. · Collects information related to issues and provides recommendations for educational material for the IBX provider community, especially where it concerns Host claims policies and processing. · Able to effectively use Internal reporting tools to manage, analyze, and perform trend analysis of open and closed inventory both onsite and offsite to meet stringent BCBS Association requirements. · Receives tracks and research Director level and above escalations for timely resolution in accordance with BCBSA escalation guidelines. · Demonstrated leadership, information driven decision-making, problem solving, organization and planning skills are essential to be successful in this position. · Effective presentation and communication skills, both oral and written are essential. · Ability to interact effectively with Providers/Partner Plan Staff at all levels and IBX associates at all levels, and across all departments. · Must be able to work efficiently in a team environment as well as individually. |
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.
Vaccination Update
This job requires that you demonstrate you have been fully vaccinated for COVID-19 prior to the start of employment, to the extent permitted by law.
About Our Company
AmeriHealth Casualty has been successfully returning employees to work since 1994, providing quality medical treatment and care and reducing costs for our customers. With our affiliates, we serve more than 1,800 businesses in the area and have offices in Philadelphia, Camp Hill, and Pittsburgh, PA, and Mount Laurel, NJ.
In 1994, CompServices, Inc. began offering workers’ compensation third-party administration services for manufacturers, municipalities, health care facilities, social services, transportation risk, universities, and retail firms. In 1996, AmeriHealth Casualty Insurance Company was established as an extension of our workers’ compensation claims services — its mission to provide workers’ compensation insurance combined with high quality claims service and cost containment.
AmeriHealth Casualty Insurance Company and CompServices write premiums and administer self-insured programs for over 1,800 customers.
Equal Employment Opportunity
AmeriHealth Casualty 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 Casualty 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 Casualty 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 Casualty or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.