Inter-Plan Relationship Coord at Independence Blue Cross LLC in Philadelphia, Pennsylvania

Job Description:

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.  

Responsibilities:

• Resolves common, complex and escalated issues directly impacting provider and member claims by working with other BCBS Health Care Plans, our members or providers


• Tracks inquiry information and provides root cause analysis and reports to Management to enable issues to be addressed at a National level


• Partners with all areas of company in order achieve timely issue resolution and compliance with other BCBS Health Care Plans’ servicing requirements


• Takes ownership of resolving a partner plan inquiry from start to completion, including when an  inquiry requires assistance of another area


• Acts as a liaison between IBC and all partner BCBS Health Care Plans to ensure end to end resolution of issues for all claims in accordance with the Inter-Plan Program (IPP) requirements


• Identifies, fixes and eliminates “operational” issues that are identified as trends/patterns of untimely, inaccurate, non-compliant or inconsistent claims adjudication for our participating providers or partner BCBS Health Care Plans involving multiple system and inquiry platforms


• Assesses, recommends, coordinates and facilitates process improvement opportunities for the Commercial and Government Operations business units


• Collects information related to issues and provides recommendations for educational material for members and providers


• Manages open inventory both onsite and offsite to meet stringent BCBS Association requirements


• Receives tracks and researches Director level and above escalations for timely resolution in accordance with BCBSA escalation guidelines. 


• Demonstrated leadership, information driven decision- making, problem solving, organization and planning skills are essential to be successful in this position.


• Effective presentation and communication skills, both oral and written are essential.


• Ability to interact effectively with Providers/Partner Plan Staff at all levels and IBC associates at all levels, and across all departments.


• Ability to organize time effectively to meet responsive turnaround times on customer issues is required.


• Performs other duties as assigned which may include travel to other plan sites as needed

• High School Diploma or GED ,4 years experience in a Claims/Service operations environment OR Bachelors degree, 2 years experience in Claims/Service environment


• Demonstrated understanding of Inter-Plan policies, processing standards and guidelines to include Home and Host responsibilities


• Demonstrated understanding of all Inter-Plan Systems


• Demonstrated understanding of Products to include Medicare Advantage, Medicare Cross-over, State Health Plan, Administrative Services Only (ASO) and Fully insured and Individual products, National Accounts Database


• Experience in the development, design and execution of account specific, customized education programs in the health care industry is preferred.

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.