Claims Payment Adjuster
Seeking a detail-oriented and analytical Claims Payment Adjuster to join our team. In this role, you will be responsible for reviewing, processing, analyzing and adjusting medical claims to ensure accuracy, compliance, and efficiency. You will work closely with other team members and cross functional teams such as configuration and Account Management to resolve discrepancies and improve claims processing workflows.
Key Responsibilities:
- Process and analyze medical claims in accordance with company policies within all client service level agreements.
- Consistently meet department quality and production standards.
- Review claims for accuracy, completeness, and compliance with Medical Policy and client unique set up Identify and investigate claim discrepancies, denials, and errors, and take action to report issues internally.
- Communicate with other plans via the BlueSquared BCBSA Application Maintain up-to-date knowledge of processing and continue to increase skill set in order to handle more complex claim scenarios.
- Provide insights to improve claims processing efficiency. Collaborate with internal teams to enhance claims handling procedures.
- Other duties as assigned by Leadership Team
Qualifications & Skills:
Experience: 3 years or more of experience in medical claims processing and adjusting or healthcare administration. Preferred experience with pre-existing condition reviews.
- Technical Skills: Knowledge of medical billing codes (ICD-10, CPT, HCPCS), HealthRules, FOS, Salesforce and the BlueCard product.
- Analytical Skills: Ability to assess claim data and identify errors or inefficiencies. Possess excellent mathematical skills and have the ability to work independently and within tight timeframes. Exposure to preexisting provisions is a plus
- Communication Skills: Strong written and verbal communication skills for interacting with various stakeholders.
- Attention to Detail: High level of accuracy and thoroughness in reviewing claims for client.
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.