Accumulator Remediation & Adjustment Reconciliation
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Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals. If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole-person health.
At Independence, 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.
Supervisor EDI Support will oversee and monitor delegated vendor and internal business owner relationships to ensure compliance, optimal delegate performance and achievement of business goals according to Service Level Standards and other contractual requirements.
Responsibilities
- Resolving all issues related to ancillary delegated relationships.
- Serve as Liaison between vendors and cross-functional internal departments and teams to ensure timely and quality deliverables from vendors and internal departments.
- Acts as a liaison between other departments and delegates related to audits, member complaints, etc. Collaborates with other departments within 3rd party vendor & CTA Adjustments to improve all aspects of a delegated functions including member satisfaction.
- Maintain effective working relationships with delegated vendors and internal business stakeholders to ensure performance metrics are met, identify opportunities for improvement, mitigate risk and eliminate barriers to correct Corrective Action Plans (CAPs).
- Analyze, track and follow-up on the timely resolution of errors and issues that are a result of vendor processes; and as necessary escalate unresolved inquiries/complaints to Manager.
- Analyze, track and follow-up on the timely resolution of Adjustment Projects and as necessary escalate issues, inquiries/complaints to Manager.
- Serve as a project coordinator to lead projects/vendor configurations as assigned, develop project plans, support workgroup, and monitor vendor and internal deliverables.
- Analyze, update, and modify procedures and processes to continually improve operations.
- Monitor and report instances of vendor Corrective Action Plans (CAPs) implement CAPs as necessary.
- Perform IT User acceptance testing (UAT) assessments related to enrollment files for 3rd party accumulator feeds as needed, claims reporting, accumulator files and as needed reviews for IT changes which impact the delegate.
- Perform IT User acceptance testing (UAT) assessments related to the Adjustment projects, claims reporting, and as needed reviews for IT changes which impact the Adjustment Projects
- Monitor electronic feeds and User acceptance testing (UAT) to ensure receipt/transmit data files to delegates.
- Identify opportunities for process improvement and efficiencies to reevaluate processes and workflows.
- Perform any other duties as may be assigned.
Qualifications
- Bachelor's Degree or higher from an accredited institution preferred
- 5 years of related experience
Knowledge, Skills, Abilities
- Demonstrated strong organizational, analytical, and interpersonal skills with detail-oriented focus.
- Demonstrated computer proficiency, including but not limited to, Microsoft Outlook and Microsoft Office Word and Excel and SQL
- MS Excel proficiency with the ability to create formulas, v-lookups, pivot tables and analyze data
- SQL proficiency with the ability to create data queries and self-serve reporting to support Accumulator and CTA department functions
- Demonstrated ability at Planning, Organizing and Executing
- Demonstrated professionalism and leadership skills along with ability to develop and direct projects
- Knowledge of health insurance/health care/managed care environment preferred.
- Time Management, Critical/Creative Thinking and Problem-Solving skills.
- Should be adaptable, flexible while working in a fast-paced environment
- Experience with Relationship/Account Management
- Utilizing effective verbal and written communication skills are essential
Hybrid of Choice:
Independence has implemented a “Hybrid of Choice” model which provides our associates with the flexibility to choose whether to work remotely, work in the office every day, or work in the office on certain days at their discretion. However, management may require our associates to work from Independence’s physical office locations on certain occasions. This role is designated as a role that fits into the “Hybrid of Choice” model. While associates may work remotely, the work must be performed in the Tri-State Area of Delaware, New Jersey or Pennsylvania.
Independence Blue Cross is committed to the health, safety, and well-being of our associates. In support of that focus, Independence expects all new hires to be up to date with COVID-19 vaccination and booster*. Independence’s policy provides reasonable accommodations for medical or religious reasons as required by law. The process for requesting a reasonable accommodation is communicated to candidates when they are offered employment.
* To be considered “up to date” with COVID-19 vaccination and booster, individuals must have received an initial series of the vaccine (whether a 1-dose or 2-dose series) and timely receive a booster once eligible. Individuals not yet eligible to receive a booster shot will be required to timely obtain a booster once eligible.
Diversity, Equity, and Inclusion
At Independence, 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.
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
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 Independence, 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
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.
Agency Disclaimer
All resumes submitted directly to an Independence Blue Cross 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 Independence Blue Cross and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.