Issue Resolution Specialist at Independence Blue Cross LLC in Philadelphia, Pennsylvania

Job Description:

Independence is a qualified health plan issuer operating in the State Based Exchange Marketplace and is required to resolve Health Insurance State Based Exchange (SBE) tickets within regulated timeframes. The Issue Resolution Specialist is the frontline resource that receives, investigates, triages, and resolves State Based Exchange tickets.

Specific Duties:

Manage and monitor caseload daily to ensure tickets are researched, processed/triaged and resolved accurately and timely, within the compliance timeframes set forth by the State Based Exchanges, and in alignment with ACA regulations and guidance, and internal policies.

Collaborate with operational departmental liaisons, and other Issue Resolution Specialists, to ensure accurate and timely resolution of SBE tickets.

Produce high quality, comprehensive and reader-friendly written responses (internal and external) that address all of the Consumers’ concerns accurately and within the required timeframes.

Expertly understand, navigate, and comply with the SBEs and ACA regulations and guidance.

Through the course of investigation, identify root causes of SBE tickets and deficiencies in organizational processes, and share suggestions to assist in developing initiatives to enhance the organization’s overall performance.

Provide regular status reports on all outstanding tickets and/or tasks.

Train and support fellow team members, as needed.

Other duties as assigned.

 Qualifications/Skills:

• Bachelor’s Degree preferred.


• 2-3 years of experience in the Healthcare industry.


• Foundational knowledge of Billing, Accounts Receivable, Accounts Payable, Claims, Enrollment, Benefits, Cash Application, and Customer Service within the Healthcare industry.


• Excellent research and investigative skills, strong interpersonal skills, and the ability to work effectively with all associate and management levels.


• Strong critical-thinking and analytical skills, along with ability to interpret and decipher complex information required.


• Understanding of the SBEs mandates and regulations related to the ACA business preferred.


• Self-motivated, highly organized, detail oriented, as well as above-average solving, verbal and written communication skills are required.


• Ability to effectively multi-task and prioritize.


• Ability to thrive in a high-pace, continuously changing environment.


• Proficient in Microsoft Excel, Access, Word, PowerPoint, and Outlook.

 

 

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.

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