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Senior Claims Examiner
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Independence Blue Cross LLC
Philadelphia, PA (In Person)
Full-Time
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Job Description
Senior Claims Examiner at Independence Blue Cross LLC Senior Claims Examiner at Independence Blue Cross LLC in Philadelphia, Pennsylvania Posted in about 2 hours ago.
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Full-Time Job Description:
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 datadriven 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 13 years of experience in claims analysis or healthcare operations Strong knowledge of medical terminology, CPT, HCPCS, ICD10 codes Proficiency in claims processing systems and Microsoft Excel Excellent analytical, problemsolving, and communication skills Ability to manage multiple priorities in a fastpaced environment IBX is an Equal Opportunity Employer.