Senior Claims Examiner
Job Summary
The Sr. Claims Examiner is responsible for analyzing, validating, and processing claims to ensure compliance with plan provisions, regulatory requirements, and internal policies. This role focuses on identifying discrepancies, improving accuracy, and supporting operational efficiency through data-driven insights.
Key Responsibilities
· Review and analyze claims for accuracy, eligibility, and compliance with benefit provisions
· Investigate and resolve discrepancies related to coding, billing, and authorization requirements
· Prepare detailed reports on claims trends and performance metrics
· Collaborate with internal teams to improve claims processes and reduce errors
· Respond to inquiries from providers and members regarding claim status and payment rationale
· Support audits and regulatory reporting as needed
Required Qualifications
- High school diploma or equivalent
- 1–3 years of experience in claims analysis or healthcare operations
- Strong knowledge of medical terminology, CPT, HCPCS, ICD-10 codes
- Proficiency in claims processing systems and Microsoft Excel
- Excellent analytical, problem-solving, and communication skills
- Ability to manage multiple priorities in a fast-paced environment
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.