Issue Resolution Specialist
Independence is a Qualified Health Plan issuer participating in the Federally Facilitated Marketplace and State-Based Exchanges (SBE). We are responsible for resolving Exchange casework within strict regulatory timeframes that directly impact members’ access to healthcare.
As an Issue Resolution Specialist, you will play a critical frontline role in investigating and resolving complex cases. This is an opportunity to apply your analytical skills, problem-solving abilities, and attention to detail to make a meaningful impact on member experiences while navigating a dynamic and highly regulated environment.
Key Responsibilities
Manage and prioritize a daily caseload to ensure cases are resolved accurately, efficiently, and within required compliance timeframes
Investigate and analyze case details, identify root causes, and determine effective resolutions
Collaborate with cross-functional teams to drive timely and accurate case outcomes
Draft clear, professional, and comprehensive written responses addressing consumer concerns
Interpret and apply ACA, CMS, and State-Based Exchange regulations in all casework
Identify trends and recommend process improvements to enhance operational performance
Provide regular status updates on open cases and assigned work
Support team training and knowledge sharing
Ensure a positive member experience through accurate, timely, and compliant resolutions
Perform additional duties as assigned
Bachelor’s degree preferred
2–3 years of experience in the healthcare industry
Skills & Experience
Working knowledge of healthcare operations such as billing, claims, enrollment, benefits, accounts receivable/payable.
Strong analytical, investigative, and problem-solving skills
Excellent written and verbal communication skills, with the ability to clearly explain complex information
Ability to interpret regulations and apply them in real-world scenarios
Highly organized, detail-oriented, and able to manage multiple priorities
Sound judgment and decision-making skills
Ability to thrive in a fast-paced, evolving environment
Proficiency in Microsoft Office (Excel, Access, Word, PowerPoint, Outlook)
Familiarity with ACA, CMS, and State-Based Exchange regulations is a plus
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.