Provider Claims Svcs Spec
Job Profile Summary
The Provider Claims Service Specialist is responsible for responding to provider inquiries and resolving issues related to claims processing, reimbursement, and pricing. This role acts as a liaison between providers and internal claims operations teams to ensure accurate, timely resolution and a high level of service in a fast-paced environment.
Key Responsibilities
- Research and resolve provider inquiries related to claim status, pricing, reimbursement, and contract interpretation
- Analyze claim processing issues to identify root causes and implement corrective actions
- Collaborate with internal departments (e.g., Claims, Configuration, Network Management) to address escalated issues
- Review and interpret provider contracts to ensure accurate claims adjudication
- Monitor and manage assigned work queues to meet productivity and quality standards
- Maintain detailed documentation of issue resolution and provider interactions
- Identify trends and recommend process improvements to enhance operational efficiency and provider experience
- Support provider education by explaining claim outcomes, policies, and procedures
Required Qualifications
- High school diploma or equivalent required; Associate’s or Bachelor’s degree preferred
- 2–4 years of healthcare claims processing or provider services experience
- Strong knowledge of medical claims adjudication and reimbursement methodologies
- Familiarity with provider contracts and pricing logic preferred
- Excellent analytical, problem-solving, and communication skills
- Ability to manage high-volume workloads and prioritize effectively
- Proficiency in Microsoft Office (Excel, Word, Outlook) and claims processing systems
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.