Manager Claims Operations
Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals. If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole-person health.
Manages all operational activities and is responsible for the accurate payment of claims and adjustments during adjudication in compliance with all governmental regulatory and Blue Cross Association requirements. Ensures accurate and cost-effective benefits administration and timely processing of all claims and member inquiries.
Manager Claims Operations Responsibilities:
· Managed department to achieve corporate and divisional goals and standards related to claims accuracy, timeliness, and productivity.
· Managed department to achieve corporate and divisional goals and standards related to providers' and members' telephone and written inquiries.
· Controls department inventory levels by monitoring incoming volumes, productivity, and staffing daily.
· Acts on daily work requirements by reallocating resources, managing the effective use of overtime, and process re-engineering.
· Manages department to attain performance guarantees, as required.
· Manages the approved budget by monitoring expenditures, reviewing monthly variances, and taking necessary and appropriate action.
· Assists in professional development of direct reports and provides motivation, recognition, and leadership through coaching, counseling, and performance appraisals.
· Provides leadership and technical support within the division on projects assigned.
· Provides technical support and leadership, as required, to other areas of the company enabling them to meet their goals.
· Reviews and authorizes the payment of high-dollar claims within established guidelines.
· Represents IBC in group and government audits and legal matters in a business and technical capacity.
· Always administers corporate and division policy within the unit.
· Performs additional duties as assigned.
Qualifications:
- Work requires at least three to five years of experience in FEP Medical Claims Processing and two years in a leadership role with direct reports.
- A minimum of a high school diploma or equivalency is required, or a degree in the absence of required experience.
Independence has implemented a “Hybrid” model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the “Hybrid” model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.
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.
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.
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.