Triage Specialist
MAG Triage Specialist Job Description
Bring your drive for excellence, team orientation and customer commitment to Independence; help us renew and reimagine our business and shape the future of health care. Our organization is looking to diversify, grow, innovate and serve, and we are looking for committed, empowered learning-oriented people to join our team. If this describes you, we want to speak with you.
Duties include, but are not limited to:
- Reviews all incoming potential appeals and grievances, through the various channels and multiple lines of business, to determine the next steps towards resolution.
- Extensively researches all of the internal systems to ensure there is a full understanding of the reason for the request and makes the initial decision on the pathway that the request will follow.
- Identifies all related documentation (internal and external review is needed) to support the disposition review and includes the information in the case file.
- Identify and document misroutes and other invalid requests to notify the initiating area of the invalid request in an effort to mitigate ongoing issues.
- Identify all circumstances that would result in cases needing to be handled/reviewed expeditiously.
- Does outreach for additional information, consent, and acknowledgement, which may include building and sending letters to members and/or providers.
- Compiles all necessary information including documentation, creates the case in the Appeals system, document and close the request.
- Well qualified applicants will possess an associate degree and/or three years related experience with customer service and/or complaints handling.
- A working knowledge of Medicare and Medicare Supplemental products is also preferred.
- In addition, the qualified applicant would demonstrate their ability to handle complex member issues, exceptional writing, editing and proofreading skills, excellent customer service, organizational, verbal, and written communication skills.
- A working knowledge of Word and Excel is a plus.
- Time management skills required.
- Able to work on a weekend rotation.
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.