Issue Resolution Specialist
Independence Blue Cross is a qualified health plan issuer operating in the State Based Exchange Marketplace and is required to resolve Health Insurance State Based Exchange (SBE) tickets within regulated timeframes. The Issue Resolution Specialist is the frontline resource that receives, investigates, triages, and resolves State Based Exchange tickets.
Specific Duties:
Manage and monitor caseload daily to ensure tickets are researched, processed/triaged and resolved accurately and timely, within the compliance timeframes set forth by the State Based Exchanges, and in alignment with ACA regulations and guidance, and internal policies.
Collaborate with operational departmental liaisons, and other Issue Resolution Specialists, to ensure accurate and timely resolution of SBE tickets.
Produce high quality, comprehensive and reader-friendly written responses (internal and external) that address all of the Consumers’ concerns accurately and within the required timeframes.
Expertly understand, navigate, and comply with the SBEs and ACA regulations and guidance.
Through the course of investigation, identify root causes of SBE tickets and deficiencies in organizational processes, and share suggestions to assist in developing initiatives to enhance the organization’s overall performance.
Provide regular status reports on all outstanding tickets and/or tasks.
Train and support fellow team members, as needed.
Other duties as assigned.
- Bachelor’s Degree preferred.
- 2-3 years of experience in the Healthcare industry.
- Foundational knowledge of Billing, Accounts Receivable, Accounts Payable, Claims, Enrollment, Benefits, Cash Application, and Customer Service within the Healthcare industry.
- Excellent research and investigative skills, strong interpersonal skills, and the ability to work effectively with all associate and management levels.
- Strong critical-thinking and analytical skills, along with ability to interpret and decipher complex information required.
- Understanding of the SBEs mandates and regulations related to the ACA business preferred.
- Self-motivated, highly organized, detail oriented, as well as above-average solving, verbal and written communication skills are required.
- Ability to effectively multi-task and prioritize.
- Ability to thrive in a high-pace, continuously changing environment.
- Proficient in Microsoft Excel, Access, Word, PowerPoint, and Outlook.
Diversity, Equity, and Inclusion
At Independence, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that 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. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the 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
Independence Blue Cross is an Equal Opportunity and Affirmative Action 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.