Claims Repricer
Position Summary
The Claims Repricer is responsible for the accurate review, adjustment, and application of pricing methodologies to medical claims. This role ensures claims are priced in accordance with provider contracts, fee schedules, and benefit structures. The position plays a critical role in maintaining pricing integrity, minimizing rework, and supporting operational efficiency in a high-volume claims environment.
Key Responsibilities
- Review and reprice medical claims to ensure accurate application of provider contracts, fee schedules, and reimbursement methodologies
- Analyze pricing discrepancies and perform adjustments to align with contractual and system guidelines
- Research complex claims scenarios, including escalations from Provider Services and Claims Processing
- Partner with Configuration, Network Management, and Claims teams to resolve pricing issues and system defects
- Validate contract terms and ensure proper interpretation within claims adjudication systems
- Maintain productivity, quality, and turnaround time standards in a high-volume environment
- Document findings and maintain audit-ready records of adjustments and issue resolution
- Identify pricing trends, root causes, and recommend process improvements to reduce errors and rework
Required Qualifications
- High school diploma or equivalent required; Associate’s or Bachelor’s degree preferred
- 2–4 years of experience in healthcare claims processing, pricing, or repricing
- Strong knowledge of claims adjudication and reimbursement methodologies (e.g., fee schedules, contract pricing)
- Experience interpreting provider contracts and pricing logic preferred
- Strong analytical and problem-solving skills with attention to detail
- Ability to manage fluctuating workloads and prioritize effectively
- Proficiency in Microsoft Office (Excel, Word) and claims systems
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.