Mgr Claims Optns
Manages associates in completing department functions and ensures that the area of responsibility runs in a cost effective and quality manner providing prompt, accurate, and professional responses. Ensures timely and accurate processing of claims processing for all products (PA & NJ) for Local and BlueCard business, including Government products Medicare Advantage & MediGap. · Represents IBX in group and government audits and legal matters in a business capacity · Maintains oversight vendor activities · Handle compliance, regulatory and delegation tasks, including meetings. · Achieve and maintain performance standards for the department in accordance with BCBSA and PA & NJ requirements · Evaluate the effectiveness and efficiency of operational areas and take action to reallocate resources as necessary. · Manage work processes, measure non-conformance and identify corporate and department policies and procedures to achieve operational efficiencies. · Interpret, communicate, and implement corporate and department policies and procedures. · Maintain positive working relationships with internal and external customers to resolve departmental issues. · Approve special consideration and handling for customers as appropriate. · Compile and prepare required data pertaining to unit performance, budget, training, surveys, projects, audits, attendance, etc. · Identifies the support and implementation of process improvements that impact overall service and reduces overall costs. |
A. A high school diploma or equivalent is required. B. 5 years’ experience in a health care or related setting, with two years in a leadership capacity · Comprehensive knowledge of claims operations, including processes, regulations, and best practices. · Excellent interpersonal and leadership skills to effectively interact with direct reports, internal teams, and external customers. · Strong organizational skills and attention to detail in a fast-paced environment that change frequently. · Problem-solving ability to identify issues, develop resolutions, and educate customers on solutions. · Exceptional communication skills with the ability to engage and convey information clearly across all levels of the organization. |
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.