Independence Blue Cross, LLC

The Provider Network Services Provider Partnership Associate supports Integrated Delivery Health Systems (IDS) and community providers including but not limited to primary care physicians, specialists, ancillary, behavioral health, and institutional providers in Pennsylvania and Delaware. Independently researches, analyzes, and addresses provider issues and concerns to achieve expected goals/outcomes within the set timeframes. Proactively educates providers on new initiatives and policy changes that impact their claims payments, including outreach for UM Vendor Management Programs. Establishes and maintains professional and effective relationships between IBC and network providers to continually improve provider satisfaction. Ensures the resolution to issues related to complex claims payment, provider data file maintenance, Quality Incentive Payments (QIPS), capitation, and medical policy. Maintains and updates the appropriate tracking issues database with...

Government Markets is seeking a Data Insight & Reporting Analyst to join the Government Markets Reporting Team. This role is responsible for data analysis and the development of reporting used by the Stars team and Government Markets to support and improve Independence's CMS Star Ratings. Key Responsibilities: • Partner with management and department leaders to define business requirements for reporting and analysis • Analyze and interpret CMS Stars data, including HOS, CAHPS, HEDIS, and Pharmacy measures • Perform statistical analysis, benchmarking, and quality rating forecasting • Program evaluation • Collaborate with internal and external stakeholders to drive improvements in Star performance • Develop, maintain, and enhance dashboards, reports, and data extracts Required Experience • Bachelor's degree in Information Systems, Computer Science, Mathematics, Statistics, Public Health, or a related field • 3+ years of data analysis experience • Experience working in...

We are seeking a detailoriented and proactive Business Analyst to manage and support our Electronic Billing Payment and Presentment (EBPP) application. This role is critical in ensuring smooth operations of our billing and payment processes, maintaining data integrity, and delivering exceptional service to internal and external stakeholders. Application Oversight: Serve as the primary point of contact for EBPP application management. Issue Management: Track, analyze, and resolve inquiries related to billing and payment processes. Error Resolution: Identify issues and errors that may exist based on the reporting and inquiries received Vendor Coordination: Act as liaison with Alacriti , our EBPP vendor, to address technical issues, enhancements, and service requests. Reporting & Analysis: Monitor system performance, generate reports, and provide insights to improve efficiency. Process Improvement: Recommend and implement solutions to optimize EBPP...

Business Configuration Analyst Specific Duties • Configures and maintains the business rules within the claims adjudication ecosystem. • Configures the HealthRules software from development into the testing and production phases. • Provides application and technical support for the HealthRules software as well as troubleshooting for end users. • Identifies researches and resolves inaccuracies and inconsistencies in the business rules as they impact claims payment and other upstream and downstream transactions. • Engages in intake with business clients to evaluate business requirements. • Recommends and implements benefit setup based on knowledge of system configuration capabilities and information obtained from business clients. • Independently evaluates business procedures and problems. • Participates in business requirements gathering sessions to identify specifications and solutions. • Creates test case scenarios for application and configuration testing...

Job Summary Supervise the daytoday claim overpayment recovery operations and support a team responsible for maximizing recoveries through claim offsets, cash collections, wire transfers, and other electronic payment methods. This role works closely with internal business and technical partners to ensure the accurate management, recovery, allocation, and reporting of claim overpayment receivables while maintaining compliance with established financial controls and operational procedures. The Supervisor is responsible for overseeing daily recovery activities, monitoring receivable inventories, managing payment allocation processes, and ensuring the timely resolution of outstanding claim overpayments across multiple claims and financial systems. This position provides leadership, coaching, and operational guidance to staff while supporting departmental goals, service levels, and recovery performance objectives. Working collaboratively with Claims, Finance, Cash Application,...

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.  The Director & Actuary, RX Underwriting , leads the actuarial, underwriting, financial forecasting, pharmacy benefit management (PBM) oversight, and client performance functions that support the organization's pharmacy business. Responsible for strategic financial analysis, pharmacy trend forecasting, pricing strategy, vendor and PBM financial oversight, client guarantee management, forecasting, regulatory compliance, and crossfunctional business partnership. Serve as the primary actuarial advisor to pharmacy leadership and key enterprise stakeholders while ensuring delivery of critical operational, financial, and clientfacing commitments Key Responsibilities: Pharmacy Financial Forecasting & Actuarial Leadership Leads pharmacy cost forecasting, reforecasts, annual operating plan development,...

The Sr. Data Insights & Reporting Analyst plays a critical role in advancing our provider accurate coding & documentation accuracy strategy across Government Markets. This position supports provider education and insights designed to help primary care practices understand the impact of accurate clinical documentation and coding on patient care, quality outcomes, and health plan performance. Working closely with Population Health, provider partners, team members, and executive leadership, this individual serves as the primary owner of the program's data infrastructure, analytics, reporting, and dashboard development. The role transforms complex claims and clinical data into actionable insights that drive provider engagement and support datadriven decision making. As a key contributor to an evolving program, the analyst will have significant opportunity to innovate, identify new performance measures, and develop creative approaches to visualizing and communicating insights...

Seeking strong Business Analyst to support BlueCard daily operations. This support will assist to move forward resolution of operational challenges, improve current processes and support project management initiatives. You will work closely with other team members and cross functional teams such as configuration and Account Management to resolve discrepancies and improve claims processing experience for BlueCard members Support the processing team with analysis of claim issues and inquiries. Perform root cause analysis and course correct identified issues for full resolution. Work with other plans to resolve issues for members Research root cause of incorrectly processed claims, failed DF and RFs. Provide solution and coordinate with appropriate team members to repair the claim and provide reeducation to the processor or submit ticket for system enhancement. Focus on applying technologies to continuously increase claims process improvements with the use of data, Bots and...

Manage Inventory Maintain claimant files. Update group/broker/carrier contact information as needed. Distribute monthly stop loss reporting. Process external pbm files monthly Open service tickets for issues and follow through to resolution. Follow up on all open items timely. Reconcile accounts, communicate discrepancies immediately. Manage working relationships with internal and external business partners. Attend meetings to resolve issues as needed. Perform other duties ad necessary or appropriate for the position Bachelor's degree in business operations or equivalent work experience More than two years working in an operations environment. Knowledge of claims processing preferred. Previous experience in Reinsurance or Stop Loss/Healthcare experience preferred. Experience working in a production driven environment. Selfstarter, highly motivated problem solver with the ability to work independently. Ability to multitask and handle deadline driven...

Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and wellbeing of the people and communities we serve. Customer Service Representative Responsibilities: • Attains and keeps current with the knowledge and skills required to provide information, service, and assistance in response to all inquiries. • Available as assigned to accept calls in a professional and courteous manner. • Determines the nature of the call and takes all possible action, including research, completing forms, or any followup, to expeditiously ensure the provision of accurate information, service, and assistance upon first contact. • Acquire knowledge of all claims systems applications and member service systems. • Prepares and forwards appropriate requests to operating areas to accomplish action required as a result of the inquiry. • Checks...

Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and wellbeing of the people and communities we serve. Job Summary: The  Supervisor of Operations  is responsible for administration of the Operational Unit within Customer Service. Responsible for ensuring that all departmental functions are completed promptly, thoroughly, professionally and accurately. Providers work leadership, assistance, and training to those supervised. Assists in the achievement of departmental goals. Responsibilities •        Supervises and implements departmental functions, policies and procedures with all internal and external contacts.  •        Evaluates effectiveness and efficiency of operational areas and takes action t reallocate resources as necessary. •        Creates and implements programs to enhance the level of service provided to...

Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and wellbeing of the people and communities we serve. SUMMARY: The Medical Policy Administrative Coordinator coordinates departmental committee functions and workflows, and develops related agendas, meeting minutes, and summary documents. Responsible for development of Medical Policyrelated communications for both internal and external audiences. DUTIES AND RESPONSIBILITIES: 1. Coordinates department committee functions, including both internal and external committees. Includes development of agendas, meeting minutes, and committee summary documents, as well as postcommittee followup communications. 2. Manages committee schedules and coordinates meeting dates, external participant participation and guest participation. 3. Ensures contracts are in place for external...

The FEP Sr. Quality Business Analyst supports FEP Claims Operations with ensuring the quality of the transaction work performed by FEP Claims Operations and the processing vendor. The FEP Sr. Quality Business Analyst also participates in the various FEP Claims Operations transaction workstreams. Review FEP transactions to ensure accuracy of transaction and system processing. Provide timely documented feedback on issues identified at the processor and/or system level and execute escalation procedures if applicable Maintain flexibility in a team environment and identify process improvement opportunities and define system impacts that may result. Ability/willingness to participate in departmental knowledge transfer activities to facilitate crosstraining efforts. Actively represents the FEP Claims Team on various projects and possesses proven ability to identify required action items and impacts. Represent FEP Claims Team on assigned projects, providing feedback and...

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.  The Senior Audit Analyst assists as a senior audit professional responsible for leading external operational audits, managing audit issue resolution and remediation, ensuring compliance with audit standards and policies, serving as a key liaison between auditors and stakeholders, reviewing audit documentation and responses for quality and accuracy, and mentoring junior audit analysts. Serve in a senior role to ensure the timely completion of operational (and some financial) external audit projects in accordance with agreedupon audit criteria, sound audit practices, and the IBC Audit Policy. Develop strategies and discuss with management approaches to resolve audit issues. Ensure all assigned deliverables are completed with the written audit expectations for the external audit project. Address all...

Bring your drive for excellence, team orientation and customer commitment to Independence Blue Cross; 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 learningoriented people to join our team. If this describes you, we want to speak with you. Vice President, Corporate Strategy & Planning. Reports to EVP Chief Strategy and Growth Officer Summary: The Vice President, Strategy & Planning leads the development, execution, and monitoring of the Enterprise Strategy and Business Plan. Serving as a trusted advisor to the Executive Leadership Team, this role partners across the organization to shape longterm growth, evaluate strategic opportunities, and drive alignment around enterprise priorities. The Vice President provides datadriven insights, market intelligence, and strategic recommendations that support decisionmaking,...

Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals. If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable wholeperson health. 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. The Quality Business Analyst or blends subject matter expertise, a passion for...

The Sales Delivery & Optimization Specialist provides specialized support to Sales team members and external stakeholders, including clients and broker/consultant partners. The position owns complex frontend processes related to renewals, administrative changes, and new business implementations, ensuring accuracy, timeliness, and client satisfaction at every stage. Responsibilities include full accountability for coordinating account details, finalizing product selections, generating pricing outputs, and driving accurate execution across underwriting, enrollment, billing, and document production. The Specialist actively engages with internal teams and external partners to plan, monitor progress, resolve issues, and implement process improvements. Success in this role requires strong analytical and consultative skills, a commitment to excellence, and the ability to deliver results that enhance operational efficiency and customer experience. Responsibilities • Serve as a...

Responsibilities Reviews submitted enrollment requests assigned via the enrollment queues. Processes according to established productivity goals while maintaining established quality goals. Takes initiative to check questions or unusual situations with management in accordance with established guidelines. Ensures thorough and timely completion of requests for additions, changes and terminations to subscriber and dependent records. Notifies the Supervisor of trends that will impact internal and external customers. Must be able to work required extra hours as dictated by business needs. Performs other duties as assigned. Qualifications Education High School Diploma or College Degree preferred. Experience Minimum 3 years of experience in the health insurance industry, with a combined focus on production and quality. College degree in lieu of experience will be considered. Knowledge, Skills, Abilities Demonstrated ability to deal effectively with...