Inter-Plan Relationship Coordinator
· Resolves common, complex and escalated issues directly impacting IBX Out-of-Area (HOST) provider claims by working with other BCBS Health Care Plans or directly with internal business teams. · Tracks issues, provides root cause analysis and escalates to Management enabling issues to be addressed at a National level. · Partners with all areas of company, especially the various IBX provider teams to achieve timely issue resolution and compliance with other BCBS Health Care Plans’ benefits requirements. · Takes ownership of resolving a partner plan inquiry from start to completion, including when an issue requires assistance of another internal area. · Acts as a liaison between IBX and all partner BCBS Health Care Plans to ensure end to end resolution of issues for all claims in accordance with the Inter-Plan Program (IPP) requirements. · Identifies and aids in establishing business requirements for system updates/changes to eliminate “operational” issues that are identified as trends/patterns of untimely, inaccurate, non-compliant or inconsistent claims adjudication for our participating providers or partner BCBS Health Care Plans involving multiple system and inquiry platforms. · Collects information related to issues and provides recommendations for educational material for the IBX provider community, especially where it concerns Host claims policies and processing. · Able to effectively use Internal reporting tools to manage, analyze, and perform trend analysis of open and closed inventory both onsite and offsite to meet stringent BCBS Association requirements. · Receives tracks and research Director level and above escalations for timely resolution in accordance with BCBSA escalation guidelines. · Demonstrated leadership, information driven decision-making, problem solving, organization and planning skills are essential to be successful in this position. · Effective presentation and communication skills, both oral and written are essential. · Ability to interact effectively with Providers/Partner Plan Staff at all levels and IBX associates at all levels, and across all departments. · Must be able to work efficiently in a team environment as well as individually. |
· Resolves common, complex and escalated issues directly impacting IBX Out-of-Area (HOST) provider claims by working with other BCBS Health Care Plans or directly with internal business teams. · Tracks issues, provides root cause analysis and escalates to Management enabling issues to be addressed at a National level. · Partners with all areas of company, especially the various IBX provider teams to achieve timely issue resolution and compliance with other BCBS Health Care Plans’ benefits requirements. · Takes ownership of resolving a partner plan inquiry from start to completion, including when an issue requires assistance of another internal area. · Acts as a liaison between IBX and all partner BCBS Health Care Plans to ensure end to end resolution of issues for all claims in accordance with the Inter-Plan Program (IPP) requirements. · Identifies and aids in establishing business requirements for system updates/changes to eliminate “operational” issues that are identified as trends/patterns of untimely, inaccurate, non-compliant or inconsistent claims adjudication for our participating providers or partner BCBS Health Care Plans involving multiple system and inquiry platforms. · Collects information related to issues and provides recommendations for educational material for the IBX provider community, especially where it concerns Host claims policies and processing. · Able to effectively use Internal reporting tools to manage, analyze, and perform trend analysis of open and closed inventory both onsite and offsite to meet stringent BCBS Association requirements. · Receives tracks and research Director level and above escalations for timely resolution in accordance with BCBSA escalation guidelines. · Demonstrated leadership, information driven decision-making, problem solving, organization and planning skills are essential to be successful in this position. · Effective presentation and communication skills, both oral and written are essential. · Ability to interact effectively with Providers/Partner Plan Staff at all levels and IBX associates at all levels, and across all departments. · Must be able to work efficiently in a team environment as well as individually. |
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.