Claims Payment Adjuster
Job Summary
The Claims Payment Adjuster is responsible for reviewing, adjudicating, and accurately processing claims in accordance with plan provisions, provider contracts, regulatory requirements, and internal policies. This role ensures timely and accurate claims payment while providing excellent service to providers, members, and internal stakeholders.
Key Responsibilities
- Review and adjudicate claims in accordance with policy benefits, payment methodologies, and contractual agreements
- Identify and resolve claims discrepancies related to eligibility, coverage, coding, billing errors, and authorization requirements
- Document claim decisions clearly and accurately within the claims processing system
- Respond to provider and member inquiries regarding claim status, payment rationale, and benefit interpretation
- Meet productivity, quality, and turnaround time standards established by the organization
- Identify trends or recurring issues and escalate appropriately for process improvement
Required Qualifications
- High school diploma or equivalent
- Minimum 1–3 years of medical claims processing or claims payment experience
- Working knowledge of medical terminology, benefit structures, and reimbursement methodologies
- Proficiency in CPT, HCPCS, ICD-10, and basic medical billing concepts
- Strong attention to detail with the ability to apply analytical and critical-thinking skills
- Effective written and verbal communication skills
- Ability to work independently and manage multiple priorities in a high-volume environment
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.