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Independence Blue Cross

Independence Blue Cross

60 jobs near Columbus, OH

Independence Blue Cross

Senior Accountant

Philadelphia, PA · On-site

$74K - $93K/yr

Support cross-functional initiatives, system enhancements, and special projects involving financial ... Demonstrated ability to work collaboratively across teams, manage multiple priorities, and meet ...

Independence Blue Cross

Supervisor Appeals RN

... Independent Review Organization (IRO) cases, and state-mandated review processes for fully insured ... Clinical Appeals Management • Oversee clinical appeals of denials from UM and delegated UM ...

Independence Blue Cross

Supervisor Appeals

Philadelphia, PA · On-site

$22.25 - $27.50/hr

Cross-Department Collaboration * Works closely with Clinical Appeals, Claims Operations, Customer ... Independent Review Organization (IRO). Process Management * Develops, updates, and documents ...

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Showing results 21-40

Senior Stop Loss Representative

Independence Blue Cross

Philadelphia, PA • On-site

$19.50 - $26.75/hr

Full-time

Re-posted 16 days ago

Independence Blue Cross rating

8.8

Company rating: 8.8 out of 10

Based on 26 frontline employees who took The Breakroom Quiz

56th of 312 rated insurance

Job description

The SR. Stop Loss Representative is responsible for the administration and reporting for branded (Blue) and unbranded (AmeriHealth) customers for Independence, Independence Administrators, and AmeriHealth Administrators.
This position is responsible for reviewing, evaluating and processing various Excess Risk and Reinsurance Claims. It is responsible for promoting positive client relationships, education and analysis of client claims losses as well as analysis and resolution of current Stop Loss reimbursement issues. Work collaboratively with our internal and external customers including Sales, Client Retention, Audit, Claims, Enrollment, Contracts, Legal, OPL, Patient Care Management, Groups, Brokers, and Stop Loss Carriers (both managing general underwriters and reinsurers).
  • Manage Inventory
  • Maintain claimant files.
  • Update group/broker/carrier contact information as needed.
  • Distribute monthly stop loss reporting.
  • Process external pbm files monthly
  • Open 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 as necessary or appropriate for the position.

Qualifications
  • Two years related experience in claims processing or stop loss and or reinsurance required

  • Ability to prioritize varied tasks to ensure the timely and accurate completion of each task

  • Self-starter, highly motivated, problem solver with the ability to work independently in a fast pace environment

  • Demonstrate exceptional comprehension and communication skill

  • The ability to perform appropriate research, make responsible decisions, and demonstrate customer-focused professionalism required

  • Excellent interpersonal skills with the abilities to collaborate through resolution.

  • Strong organizational skills and attention to detail capabilities are required.

  • Obtain and maintain the necessary skills to access information from various systems in order to efficiently handle inquiries and submit claim filings

  • Strong oral and written communication skills required

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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