Independence Blue Cross, LLC

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. Associate Research Support Specialist: • Evaluate escalated business incidents to ensure that information provided is complete and displays a clear definition of the issue. • Determine the appropriate assignment group for incident based on incident protocols. • Decide the next steps needed to bring an issue to resolution. • Research the applicable source systems to figure out the nature of the issue. • Identify which business areas need to be engaged to bring the issue to resolution. • Provide clear and complete work notes so users clearly understand the progress and status of every incident. • Ensure a root cause is identified for each issue; the correction is made, and...

The Medical Director, Clinical Payment Integrity provides clinical oversight of payment integrity programs, reimbursement policy interpretation, provider engagement, and payment accuracy initiatives. This role serves as the clinical bridge between the health plan, providers, and internal stakeholders, ensuring payment integrity activities are clinically sound, operationally effective, and aligned with contractual and regulatory requirements. Partners closely with Utilization Management, Quality, Network Management, Payment Integrity, Informatics, Legal, and Compliance teams to advance payment accuracy, affordability, provider collaboration, and healthcare quality. This is an opportunity to help establish and expand a growing Clinical Payment Integrity function, influencing future strategy, governance, program development, and provider engagement capabilities. Key Responsibilities Clinical Payment Integrity Oversight & Reviews Conduct physicianlevel clinical reviews and...

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...

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...

Responsibilities Responsible for accurate and timely handling of claim issues for Local and Commercial PA and AHNJ, and Government market. Applies and maintains knowledge of claims processing and support systems. Research inquiries received from all areas, inclusive of internal and external sources (e.g. other plans, providers, legal, Sales); as required, perform member or provider payable claim payment adjustments when appropriate following the correct processing guidelines. Meet departmental quality and production requirements Respond professionally to internal and external inquiries, as appropriate, while maintaining corporate and departmental standards. Research claims that are paid incorrectly; recover overpaid and underpaid claim dollars from multiple sources and ensure all necessary transactional steps are taken to accurately process claim adjustments. Provide response to general questions within expected departmental standards of initial inquiry; provide daily...

Responsibilities • Responsible for supervising and overseeing team responsible for benefits, medical policy and product operations enablement. Solutions for complex benefit exceptions in FOS and HRP. • Manage team and implement departmental policies and procedures with all internal and external business partners. • Evaluates projects, mandates, initiatives, capacity plans and efficiency of department and takes actions to assign resources and estimate work effort appropriately. • Responsible for overseeing and managing team ticket inventory to ensure timely resolution across client setup teams. • Responsible for identifying trends to improve quality and inform training and DLP needs. • Ability to synthesize data to develop a clear course of action based on information from a variety of sources. • Develop and ensure timely, complete, and accurate responses to business partners. • Collaborate with Operational leaders to identify business process improvement...

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...

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. Sr. Audit Analyst Responsibilities: • Ensure the meeting of the timeline for external audits. • Address the most problematic and difficult functions associated with the External Audit function to ensure timely and complete execution of external audits in accordance with sound audit practices and regulations. • Review all internal responses from departments for accuracy and completeness. • Modify responses to address properly the audience for an internal or external party. • Prepare audit supporting documentation. • Perform and develop operational audits and provide results. • Monitor the resolution of systemic issues. • Serve as information resource to Audit 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 Model Audit Rule (MAR) Auditor is responsible for planning and executing the NAIC Model Audit Rule (MAR) compliance audit. MAR is a financial reporting regulation that requires insurance companies to issue a written report (Management's Report of Internal Control over Financial Reporting) to Insurance Departments regarding the effectiveness of internal controls over the statutory financial reporting process. This role involves assessing the effectiveness of those internal controls, ensuring compliance with MAR requirements, and identifying areas for improvement. The Senior Auditor will work closely with various departments to ensure the integrity of the organization's financial operations and reporting. Key Responsibilities: • Assist in the development, coordination, and execution of the annual...

The Associate Account Executive works with the Account Sales Rep and Management to manage external customer, client, consultant, or broker relationships. Assists in the development and execution of sales strategy for each group customer or prospect. Participates in sales meetings, presentations, and site visits to cultivate account relationships. Ensures all sales and account related issues are addressed. Builds effective relationships with customers, clients, consultants, or brokers in which maximize sales opportunities Participates in sales meetings, presentations, and site visits to cultivate account relationships with Group Leaders, Consultants, Brokers, and Members. Attends external events with clients as needed. Works with Account Sales Rep to ensure that all sales and account related issues are addressed. Communicates status, issues, risk, exposure, and recommendations to same on a timely basis. . Builds effective relationships with...

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. The Executive Assistant provides administrative, operational support to the vice president (VP) of Medical Management & Med Policy while maintaining confidentiality. This role serves as a trusted partner to the VP and supports the effective functioning of the medical management leadership team, including calendar and meeting management, preparation of executive materials, coordination of confidential communications, and followthrough on key operational priorities. The incumbent must exercise sound judgment, discretion, professionalism, and initiative while working in a highly regulated healthcare environment that includes medical policy, utilization management, regulatory, provider, and enterprise leadership activities....

Associate Customer Care Navigator (Behavioral Health): 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. Description 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. The Associate Customer Care Navigator utilizes critical thinking skills and asks probing questions to identify customer needs. Analyzes needs and coordinates with other service and technical departments to develop and deliver appropriate solutions for each customer. Proactively identifies additional resources that can improve the member health journey....

The Manager, Medicare Marketing Systems, Reporting & Insights leads the strategy, delivery, and performance of the platforms, automation, and analytics that power Medicare marketing and sales teams. This managerlevel role owns the marketing and enrollment technology stack, drives AI and automation that improve speed and accuracy across the leadtoenrollment/retention funnel, and turns data into insights that guide leadership decisions all while advancing data governance, CRM integrity, and compliance. The role partners across Marketing, Medicare Group and Individual Sales/Telesales BPO partner(s), Operations, Compliance, and BTS, and manage key external vendor relationships while also being responsible for the development of a team of analysts/specialists who deliver scalable, measurable business impacts daily to support growth across products and regions. Responsibilities Systems & Platforms • Own the roadmap, configuration, and performance of Medicare specific...

Independence Blue Cross (IBX) is looking for a Senior Research Analyst in a unique role that combines healthcare policy and outcomes with advance analytical functions aimed at improving wholeperson health for our members while aiming to reduce medical cost. This position will report to the Manager, Reporting and Analytics within the Informatics Department of IBX to perform three key functions: 1) Support IBX's Health Value Optimization (HVO) initiative by evaluating changes to medical and claims payment policies, the effectiveness of external health vendors, and deliver insights for medical cost savings opportunities. 2) Support IBX's Behavioral Health (BH) endeavors and provide insights and solutions to improve members' physical and mental health wellbeing. 3) Grow IBX's Health Equity endeavors by analyzing the impact of social determinants of health on our membership and explore possible solutions to overcome social risk barriers. Primary Responsibilities • Expert in using...

Job Summary The Client Solutions Specialist is responsible for researching, resolving, and tracking client and partner inquiries in a timely, accurate, and professional manner for all Level Care Health Carpenter Funds. This role requires strong attention to detail, effective written and verbal communication, sound judgment, and the ability to manage multiple priorities in a fastpaced healthcare operations environment. A successful candidate will demonstrate initiative, accountability, teamwork, and a processoriented approach while collaborating with internal and external partners to support highquality service delivery. Key Responsibilities • Research, investigate, and resolve daily inquiries accurately and within established department guidelines. • Monitor assigned inquiries from receipt through resolution, ensuring timely followup and clear documentation. • Provide regular status updates on outstanding tasks, open inquiries, and pending followup items via email, internal...

Vice President, Organizational Effectiveness & Workforce Transformation Position Summary Reporting to the Chief People and Culture Officer, the Vice President, Organizational Effectiveness & Workforce Transformation partners with executive leaders, HR Business Partners, and business leaders across IBX and AmeriHealth Caritas to advance strategies that strengthen organizational effectiveness and talent strategies that advance enterprise growth and performance. The role serves as an enterprise architect for talent, leadership, workforce, and skills strategies, helping the organization anticipate and prepare for evolving workforce, skill, and leadership needs, including the impact of emerging technologies, AIenabled work, and changing workforce expectations. The role is also responsible for advancing the organization's transition to a skillsbased talent strategy that aligns workforce capabilities, learning investments, career development, and business priorities. The Vice...

The Business Analyst supports vendor performance management for Appeals operations by analyzing performance data, identifying root causes of quality and compliance gaps, and supporting governance routines. This role partners with internal teams and vendor partners to improve appeals accuracy, turnaround time, and overall service performance while ensuring adherence to regulatory and contractual requirements. Primary Responsibilities Assist Vendor Onboarding and Offboarding activities through the contract lifecycle Analyze Appeals performance (TAT, quality, overturn rate, inventory, productivity) to identify trends and risks Monitor appeals inventory and case aging to support timely and compliant processing Conduct root cause analysis on quality defects, overturns, and documentation gaps Support vendor oversight, including SLA monitoring and issue resolution tracking Develop reporting and executiveready summaries for leadership and business reviews Support Monthly...

The Manager, Member Marketing will be accountable for acquisition and retention consumer strategy across existing PA and NJ markets as well as the gotomarket strategy when entering new markets. This individual will manage all pipeline planning and resource allocation to ensure timely and relevant targeting to attain new members using highperforming, validated strategies as well as explore, measure, and validate new strategies. This individual will also be accountable for the creation and deployment of onboarding materials that welcome new members and educate them on plan benefits, coverage, and digital tools. Additionally, they will oversee the design, governance, and continuous optimization of clinical messages to improve adherence, preventive care completion, and chronic condition management. The individual who fills this role must demonstrate expertise in and comfortability with direct marketing strategies, an understanding of technology, ability to work with and interpret...

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. Reporting to the Director of Corporate Accounting and Financial Reporting, the Manager of Financial Reporting is a key leader within the Corporate Accounting function, responsible for overseeing financial close, financial reporting, statutory reporting, and regulatory reporting activities for Independence Health Group (IHG) and its subsidiaries. This role ensures all reporting deliverables are accurate, complete, timely, and supported by appropriate documentation, while complying with GAAP, Statutory Accounting Principles, regulatory requirements, and internal policies. The Manager leads and develops a team responsible for the daytoday execution of reporting activities, including workload management, review of deliverables,...