Analysis Skills, Auditing, Communication Skills, Customer Support/Service, Detail Oriented, Documentation, External Audit, Market Segmentation, Medicare, Multitasking, Presentation/Verbal Skills, Reconciliation, Sales, Time Management, Writing Skills
Benefit Validation Specialist-Benefit Maintenance
- Assess and review all client setup and benefit related tickets
- Support SWAT team working high priority and time sensitive issues
- Work reconciliation and fallout reports timely and accurately
- Serves as liaison with vendors and all entry points for benefit related tickets identified and submitted by Customer Service, Sales, Member Appeals, Executive inquiries
- Review and identify appropriate documentation and rules to support accurate responses to tickets
- Handle Benefit Incidents for all lines of business and all market segments in PA and NJ as well as Medicare Advantage Plans Fully Insured and Self-Funded.
- Sources used are across several applications including, product configurator, FOS and HRP.
- Utilize client setup and benefit expertise to respond to customer audits being managed by the External Audit team
- Review and provide specific supporting detail and appropriate written responses that are deemed appropriate to share with key, critical, highly visible customers
- Facilitate discussions to ensure various departments are aligned in understanding of rules and benefit setup
QUALIIFICATIONS:
- Bachelor's degree or equivalent experience
- 3-5 years of related experience
- Proven effective communication and analytical skills required to convey complex ideas and concepts by management
- Must be detail oriented and understand corporate objectives
- Proficient skills with Microsoft office
- Must have strong emphasis to details
- Excellent written and verbal communication skills
- Ability to multi task
Hybrid
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.
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.
B
Blue Cross and Blue Shield Association
At the Blue Cross and Blue Shield Association (BCBSA), we provide business strategy, technical support and consulting expertise to 36 Blue Cross and Blue Shield companies across the nation, employing more than 1,000 of the best strategic thinkers in the industry. We are a Brand manager that sets quality control standards for the 36 independent companies that use the Blue Cross and Blue Shield Brands, and we serve as a trade association that represents these Blue companies. It is through our involvement that the Blues companies share a united vision and strategy while also benefiting from the local strength of all member companies.
2,000 to 2,499 employees
https://www.bcbs.com/about-us/careers