Benefits Validation Specialist
Benefit Validation Specialist-Benefit Maintenance
· Assess and review all client setup and benefit related tickets
· Support SWAT team working high priority and time sensitive issues
· Work reconciliation and fallout reports timely and accurately
· Serves as liaison with vendors 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 Fully Insured and Self-Funded.
· Sources used are across several applications including, product configurator, FOS and HRP.
· Utilize client setup and benefit 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
QUALIIFICATIONS:
· 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 multi task
Hybrid
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.
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.
Inclusion and Belonging
At IBX, everyone can feel valued, supported, and comfortable to be themselves, and 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. Celebrating and embracing 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 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
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.
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.