Blue Cross & Blue Shield jobs in Philadelphia, PA - 31 jobs

Quality assurance reviews play a critical role in helping business areas assess team performance, strengthen operational effectiveness, and make data driven decisions that support process improvements and organizational change. The Manager, Quality Assurance & Compliance oversees quality assurance programs across multiple operational functions and leads a team of QA supervisors and audit professionals in driving continuous improvement and operational excellence. This role champions the organization's strategic goals by ensuring alignment with enterprise quality standards, internal and external audit requirements, and compliance expectations. Strong partnership with Operational Leadership, Compliance, and Internal Audit is essential to enhance accuracy, efficiency, and overall transaction quality. The ideal candidate is a strong communicator and strategic thinker who demonstrates adaptability, sound judgment, and the ability to respond effectively to evolving business needs. Key Responsibilities: * Oversee all quality-related operational activities across customer service, client setup, appeals, enrollment, billing, and other operational areas, ensuring timely issue identification, thorough audit documentation, comprehensive analysis, and clear communication of results to Operations and Compliance teams. * Drive process optimization initiatives and maintain rigorous standards of quality and compliance throughout the organization. * Assume accountability for operational transaction auditing in support of regulatory compliance audits and client Performance Guarantees (PGs) reporting. * Actively manage daily workflow, productivity, and accuracy of quality analysts to ensure consistent performance against established expectations and standards. * Collaborate with internal business partners to facilitate effective problem resolution, conduct root cause analyses, and advocate for high-quality operational performance, promptly addressing and resolving instances of substandard quality. * Support internal, external customer, third-party, state, and federal audits by providing required data, validating reports, and submitting documentation in accordance with all relevant guidelines and specifications. * Deliver operational performance metrics and trend analyses across daily, weekly, and monthly intervals, partnering with Operational Leaders, Compliance, and Internal Audit to enhance efficiency, strengthen accuracy, and drive sustained process improvements. * Deliver operational performance metrics and conduct trend analyses to monitor key metrics on a daily, weekly, and monthly basis. Ensure regular engagement with Operational Leaders, Compliance, and Internal Audit to optimize efficiency, strengthen accuracy, and drive sustained process improvements. * Provide strategic leadership in the professional development of direct reports by fostering engagement, recognition, and growth through effective coaching, performance guidance, and development planning to support individual and team success. * Bachelor's degree in Business Administration, Information Systems, Computer Science, Data Analytics, or related field. * Minimum of eight (8) years of relevant experience across various operational disciplines. * Demonstrated expertise in quality assurance standards, including plan development, change control, and documentation practices. * Extensive experience in administration of benefits and claims handling. * Advanced analytical and technical proficiency in leveraging data analytics to investigate root causes of deficiencies and assess the effectiveness of controls. * Proven ability to manage multiple projects within a dynamic development environment. * Demonstrated proficiency in defining business solutions, making informed decisions, identifying and resolving problems, coordinating resources, and implementing organizational changes. * Demonstrates strong attention to detail and a clear understanding of corporate objectives, with the ability to manage projects and implementations throughout their life cycle while consistently meeting established deadlines. * Exceptional verbal and written communication skills. 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.

The Manager, IT Category Management, is responsible for directing all sourcing and vendor contracting activities within the assigned categories. This role supervises staff engaged in the sourcing process for high-value and complex goods, services, or projects and initiatives. The incumbent focuses on reducing organizational costs by implementing effective sourcing strategies, tools, and processes. Coordination with third-party vendors, business owners, and the legal team is essential for the preparation, analysis, and negotiation of vendor contracts. Additionally, this position supports business owners across all functional areas in technology vendor selection and ensures that vendor obligations are documented in alignment with business requirements. What You'll Do Manage staff responsible for the development and execution of sourcing strategies in one or more technology categories. Direct and train staff in conducting sourcing events, including development of project work plan, category profile, category strategy, minimum requirements and evaluation criteria, solicitation Guide staff in the development and implementation assorted bid documents and requests (i.e. RFP, RFI, RFQ); and manage status reporting and performance metrics of sourcing and category management activities. Understand, analyze and forecast complex market and industry dynamics and share subject matter expertise and industry knowledge within the established portfolio of products and services Partner with stakeholders to develop business and sourcing strategy and source products and services using proven tools, processes, and analytics to drive and achieve business results. Coordinate the evaluation and analyses of sourcing results from a total cost of ownership perspective, and provide optimization recommendations Lead cross-functional teams responsible for complex vendor negotiations, including those that require specialized subject matter expertise, nonstandard risk mitigation solutions, and coordination of multiple arrangements. Proactively establish and foster successful, positive working relationships with vendor personnel. Drive vendor engagement through formal and informal transactions. Manage contract management function and facilitate effective collaboration with Corporate Compliance, Legal, Audit and Risk Management and other internal stakeholders for compliance activities to ensure regulatory conditions are met. Develop new procedures, training, initiatives, specifications and recommendations for process or policy changes and improvements, as appropriate. What You Bring Bachelor's degree or advanced degree (where required) 8+ years of experience in related field. In lieu of degree, 10+ years of experience in related field. Bonus Points 8+ years Technology procurement experience Highly Preferred Procurement experience at a healthcare company Highly Preferred Procurement experience with key vendors including IBM, Microsoft, Salesforce, ServiceNow, Cognizant, Accenture, NTT Data and HCL Technologies Experience purchasing hardware and software through Value Added Resellers What You'll Get The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community. Work-life balance, flexibility, and the autonomy to do great work. Medical, dental, and vision coverage along with numerous health and wellness programs. Parental leave and support plus adoption and surrogacy assistance. Career development programs and tuition reimbursement for continued education. 401k match including an annual company contribution Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance. $107,901.00 - $172,642.00 Skills IT Procurement, Negotiation, Strategic Sourcing, Vendor Procurement

The Provider Network Services Senior 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 current statuses and next steps. Collaborates with other departments within the organization to assist with resolution of complex provider issues. 1. The candidate must have a bachelor's degree or equivalent work experience. 2. Minimum five years' progressive experience in a health-care related organization is required, with experience in Provider Networks, Contracting, Claims Processing or Managed Care Operations strongly preferred. 3. Knowledge of professional billing requirements, reimbursement methodology, IBC/AmeriHealth products, medical policy, and benefits. 4. Proficiency with Outlook, Word, Access, and Excel (including pivot tables, filters, and formulas). 5. Experience using multiple IBC systems and the suite of en Gen applications including but not limited to: INSINQ, OCWA, OSCAR, HRP, Aerial, OneHub, Provider Profiles, and PGRS. 6. Proven ability to conduct educational programs using a multi-media approach to small and large groups. 7. Prior experience in a service-oriented role strongly preferred. 8. The candidate must be self-motivated with strong interpersonal, analytical, problem-solving, organizational, time management, and written and verbal communications skills. 9. Ability to independently manage multiple priorities with varying levels of complexity and customer expectations to a successful conclusion with limited supervision is essential, as is the ability to interact effectively with all levels of management, including medical directors. 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.

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 well-being of the people and communities we serve. Are you passionate about tackling complex challenges and making a real impact? Join our dynamic team where your critical thinking and problem-solving skills will drive meaningful change for our clients and members. Why This Role Matters: you are the linchpin in ensuring our clients and members receive timely, accurate, and thoughtful solutions to their most pressing issues. You'll be empowered to investigate, analyze, and resolve multifaceted inquiries, collaborating with cross-functional teams and directly shaping the customer experience. Your work will help us deliver on our promise of excellence and innovation in healthcare operations. Specific Duties * Lead enterprise wide programs of multiple related projects toward a common objective * Work with junior level Project Managers to monitor cost schedule, and technical performance of component projects and operations, while working to ensure the ultimate success of the program. * Set an example for meeting PMO compliance and advocating for delivery operational excellence. * Determine and coordinate the resource-sharing among constituent projects to the overall benefit of the program. * Execute both internal and external stakeholder management * Work with senior management to determine and coordinate the sharing of resources among their constituent projects to the overall benefit of the program. * Translate detailed information into a clear and concise summary appropriate for executive review Knowledge Summary * Expert knowledge and expertise in the use of Project Management methodologies and tools. * Expert written verbal communication skills. * Proven ability to translate detailed information into a clear, concise summary appropriate for executive consumption. Education & Experience * Bachelor's Degree or equivalent experience; Master's Degree preferred. * 10 or more years of related work experience. * 7 or more years' of experience managing projects. 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.

The 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 current statuses and next steps. Collaborates with other departments within the organization to assist with resolution of complex provider issues. MAJOR ACTIVITIES: 1. Independently supports health systems and services community providers, including but not limited to primary care physicians, specialists, ancillary, behavioral health, and institutional providers. Educates providers concerning new initiatives and policy changes that impact their claims payments. 2. Handles Provider Validation Roster requests within established timeframes. Ensures completion/submission of all necessary change forms to support the Provider Roster Validation process. 3. Ensures that key goals and objectives are accomplished in keeping with established priorities and timeframes. 4. Performs research and analysis of all provider issues received both externally and internally. Addresses provider issues and concerns to ensure that expected goals/outcomes are achieved within the set timeframes. 5. Maintains and updates the appropriate tracking issues database with current statuses and next steps. 6. Conducts root cause analysis and works collaboratively with staff in other business areas to assist with the resolution of complex provider issues and achieve expected goals/outcomes within established timeframes, requesting the support of management when needed. 7. Uses the information gained during servicing activities to make recommendations to management regarding the identification of significant opportunities to improve operational efficiency, reduce costs and improve provider satisfaction. 8. Establishes and maintains professional and effective relationships between IBC and practice administrators, medical directors, and practitioners to ensure compliance with contractual obligations, applicable State & Federal regulatory requirements, accreditation standards, and corporate policies. * Develops and maintains professional and effective relationships with various levels of management within IBC to achieve successful outcomes. Identifies policies and procedural issues and recommends potential resolutions by working with management. * Completes assigned projects to support corporate initiatives within the timeframe set by Management. * Supports other members of the team to ensure that service levels and goals are met. * Performs other duties as assigned. 1. The candidate must have a bachelor's degree or equivalent work experience. 2. Minimum five years' progressive experience in a health-care related organization is required, with experience in Provider Networks, Contracting, Claims Processing or Managed Care Operations strongly preferred. 3. Knowledge of professional billing requirements, reimbursement methodology, IBC/AmeriHealth products, medical policy, and benefits. 4. Proficiency with Outlook, Word, Access, and Excel (including pivot tables, filters, and formulas). 5. Experience using multiple IBC systems and the suite of en Gen applications including but not limited to: INSINQ, OCWA, OSCAR, HRP, Aerial, OneHub, Provider Profiles, and PGRS. 6. Proven ability to conduct educational programs using a multi-media approach to small and large groups. 7. Prior experience in a service-oriented role strongly preferred. 8. The candidate must be self-motivated with strong interpersonal, analytical, problem-solving, organizational, time management, and written and verbal communications skills. 9. Ability to independently manage multiple priorities with varying levels of complexity and customer expectations to a successful conclusion with limited supervision is essential, as is the ability to interact effectively with all levels of management, including medical directors. 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.

* Lead the end-to-end broker commission process, including calculation, validation, and payment. * Collaborate with BTS teams to ensure enrollment and billing data properly captured within the commission system for accurate commission calculations * Have knowledge of how to correctly review Billing information within ORMB, CABS, and Advantsure to ensure commission calculations are accurate * Develop and maintain reporting tools to track commission payments and resolve discrepancies. * Serve as the primary point of contact for broker commission inquiries, providing timely and professional resolution. * Identify process improvement opportunities and implement best practices to enhance efficiency and accuracy. * Ensure compliance with regulatory requirements and internal policies. * Minimum of 5+ years in billing, enrollment, and A/R functions, with at least 2 years at a senior or lead level. * Strong understanding of health insurance operations and broker commission structures. * Advanced proficiency in Excel and data analysis tools; experience with ERP or commission systems preferred. * Excellent problem-solving skills and attention to detail. * Strong communication and collaboration abilities across multiple teams. 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.

* Resolves common, complex and escalated issues directly impacting IBX Out-of-Area (HOST) provider claims by working with other BCBS Health Care Plans or directly with internal business teams. * Tracks issues, provides root cause analysis and escalates to Management enabling issues to be addressed at a National level. * Partners with all areas of company, especially the various IBX provider teams to achieve timely issue resolution and compliance with other BCBS Health Care Plans' benefits requirements. * Takes ownership of resolving a partner plan inquiry from start to completion, including when an issue requires assistance of another internal area. * Acts as a liaison between IBX 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 and aids in establishing business requirements for system updates/changes to eliminate "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. * Collects information related to issues and provides recommendations for educational material for the IBX provider community, especially where it concerns Host claims policies and processing. * Able to effectively use Internal reporting tools to manage, analyze, and perform trend analysis of open and closed inventory both onsite and offsite to meet stringent BCBS Association requirements. * Receives tracks and research 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 IBX associates at all levels, and across all departments. * Must be able to work efficiently in a team environment as well as individually. * Resolves common, complex and escalated issues directly impacting IBX Out-of-Area (HOST) provider claims by working with other BCBS Health Care Plans or directly with internal business teams. * Tracks issues, provides root cause analysis and escalates to Management enabling issues to be addressed at a National level. * Partners with all areas of company, especially the various IBX provider teams to achieve timely issue resolution and compliance with other BCBS Health Care Plans' benefits requirements. * Takes ownership of resolving a partner plan inquiry from start to completion, including when an issue requires assistance of another internal area. * Acts as a liaison between IBX 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 and aids in establishing business requirements for system updates/changes to eliminate "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. * Collects information related to issues and provides recommendations for educational material for the IBX provider community, especially where it concerns Host claims policies and processing. * Able to effectively use Internal reporting tools to manage, analyze, and perform trend analysis of open and closed inventory both onsite and offsite to meet stringent BCBS Association requirements. * Receives tracks and research 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 IBX associates at all levels, and across all departments. * Must be able to work efficiently in a team environment as well as individually. 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.

Please note: This posting does not represent a formal job opening, but rather, we are seeking to collect Medicare talent for future job openings. Medicare experience is required. Resumes without demonstrated Medicare experience will not be considered. Thank you! Consistently rated among the top Medicare products in the region, Independence is looking for great talent with experience in Medicare, including Advantage, Supplement, SNP and Part D, for upcoming opportunities within Government Markets. For over 80 years, we have been enhancing the health and well-being of the people and communities we serve by delivering innovative health care products and services, coordinated, quality care, and supporting programs and events that promote wellness. Opportunities within our Government Markets Medicare organization include: * Analytics * Product Management & Development * Leadership * Regulatory & Compliance * Marketing * Sales * STARS * Risk Adjustment The experience required varies by role, however, additional qualifications for opportunities include: * Bachelor's degree or any combination of education and experience, which would provide an equivalent background. * Minimum 3 years Medicare experience * Demonstrated ability to work in a rapidly changing, dynamic managed care environment while maintaining CMS requirements. * Demonstrated proficiency with CMS and State Insurance Regulations * Excellent interpersonal, presentation and communication (both verbal and written) skills required.Strong organizational, presentation and facilitation skills. * Detail oriented with strong analytical skills and problem-solving skills * Knowledge of the Microsoft office suite of products 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.

* Responsible for accurate and timely handling of claim issues for all lines of business, including bi-directional sharing, FEP, Local and Commercial PA and AHNJ, BlueCard 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 feedback, status updates and targeted resolution dates for more complex issues. * Complete special projects and participate in work groups as assigned. * Perform other duties as necessary * High School graduate or equivalent work experience. Experience * 1 - 3 years proven work experience in a production environment. Knowledge, Skills, Abilities * Demonstrated math and comprehension skills required. * Good interpersonal skills for handling internal and external customers. * Well-developed listening, verbal and written communication skills. * Proficiency with Microsoft Office, specifically Excel and Word is required. * Ability to research and investigate information using multiple sources, operating systems and documented guidelines. * Must have strong organizational skills and problem solving ability. * Must be detail-oriented 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.

About the Department: The Accumulators Team is responsible for ensuring the accurate tracking and synchronization of deductible and out-of-pocket balances across multiple vendors. This work is essential to maintaining seamless benefits administration and delivering a positive member experience. Co-op Job Description: As a Co-op on the Accumulators Team, you will support key operational and analytical functions that ensure data integrity and process efficiency. You'll gain hands-on experience in auditing, troubleshooting, and collaborating across departments to support business-critical systems. Key responsibilities may include (but are not limited to): * Conduct audits, analyze data, test system functionality, and document findings and decisions throughout the lifecycle of assigned tasks and projects. * Identify and recommend opportunities for process improvement and automation by evaluating current policies and procedures. * Provide troubleshooting and problem-resolution support related to audits, adjustments, and accumulator discrepancies, engaging subject matter experts as needed. * Make decisions in alignment with standard policies and procedures; escalate deviations for management approval. * Collaborate with internal and external stakeholders to ensure accurate and timely resolution of issues. Required Skills and Qualifications: The ideal candidate will demonstrate: * Proficiency in Microsoft Office Suite, particularly Excel and Access. * Familiarity with SQL is a plus. * Strong analytical, problem-solving, and communication skills. * Ability to work independently and as part of a team. Required Skills and Qualifications: The ideal candidate will demonstrate: * Proficiency in Microsoft Office Suite, particularly Excel and Access * Familiarity with SQL; proficiency preferred * Strong analytical, problem-solving, and communication skills * Ability to work both independently and collaboratively in a team environment * Self-motivation with a proven ability to meet deadlines * Excellent organizational and time management skills Accepted Majors: * Information Systems * Information Technology * Computer Science * Accounting Classification: * Junior or Senior undergraduate students * Recent graduate (within one year of the program start date) GPA Requirement: * 3.5+ or higher Independence Blue Cross is an Equal Opportunity and Affirmative Action 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.

The Senior Self-Funded Billing Analyst works with both IS and business professionals internally and at the self-funded group or their consultant. The position also works with and has the ability to communicate at both a technical and business level. The Senior Billing Analyst will be responsible for the following: * Overseeing a portfolio of Top Self-Funded clients. The requirements will be to handle the detailed preparation of Self-Funded customer invoices, customer setup, accounts receivable reconciliations, and aging results. The Senior Billing Analysts are also responsible for customer related projects involving customer inquiries, collections, audits, reconciliations and settlements. This position will work closely with the clients. * Responsible for performing the invoicing, reconciling and maintenance of self-funded customer accounts. Will gather the receivable facts and report to the lead. Will input A/R comments for their clients. * Will prepare the results of the Settlements/Reconciliations. * Will develop as needed Ad Hoc reports. Will ensure that payments are properly allocated/applied. * Ensuring that the weekly and monthly bills are sent out on a timely basis. Will ensure the accuracy of the bills. Will have some interaction with the clients. * Will follow key internal controls and supporting testing work by internal and external audits. Escalate setup and billing issues to appropriate levels of management. Document specific customer issues. Ex: over/under payments, setup issues, etc. * Reconcile billed amounts to billing control totals to ensure G/L balancing of billable medical experience. Communicate variances to accounting and / or respond to questions from accounting. * Responsible for ensuring the assigned portfolio of customer accounts are maintained and reconciled on a weekly and monthly basis. * Assist the Lead with the self-funded billing department and IBC interests in meetings with both internal and external customers. Internal customer meetings will include corporate & departmental projects as well as customer specific discussions where business solutions and project requirements are developed. External discussions with customers require knowledge of the billing processes and outputs, the customers' perspective and political savvy. * Training the new staff members. As part of the on boarding process will assist the supervisor in training various job functions. * Handles complex customer accounts * Minimum 3 - 5 years working within a Billing, Finance or, Operations Department. * Billing experience in a Healthcare / Insurance Industry preferred. * Proficient with Microsoft Excel, Word, and Outlook. Knowledge of SQL, Access, and Abode Standard. Having knowledge of Web based applications and having PeopleSoft is a plus. * Ability to multi task and prioritize activities. * Excellent written and verbal communication skills. 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.

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 whole-person health. We are seeking a dynamic Manager of Reporting & Analytics who can transform complex data into actionable insights and craft compelling stories that drive strategic decisions. This role is ideal for a data-driven leader with strong business acumen and the ability to influence senior executives through clear, impactful presentations. This position is within the Operations Reporting & Analytics team and supports operational improvement initiatives. Responsibilities: * Demonstrate strong analytical capabilities with expertise in hypothesizing and deriving valuable insights from diverse data sources; possess proficiency in data comprehension, processing, extraction, visualization, and effective communication of findings to varied audiences, including senior management. * Anticipate leadership questions and proactively develop analyses and visualizations that address emerging business needs and identify opportunities for process improvement * Automate detection of key factors driving metric variance for quicker root cause analysis. * Deliver clear and concise presentations of analysis results tailored for senior leadership and provide reliable, data-driven recommendations as a trusted advisor. * Lead, mentor, and develop a team of reporting analysts, fostering ongoing advancement in both technical skills and business acumen Skills/Qualifications: * Bachelor's degree in Data Analytics, Business, Statistics, or related field; Master's preferred. * Minimum 10+ years proven work experience in reporting, analytics, or business intelligence roles * Previous managerial experience preferred * Advanced proficiency in data visualization tools (e.g., Power BI, Tableau). Strong SQL and data modeling skills. * Ability to clean, wrangle, and transform large, complex data sources, using fit-for-purpose data analysis techniques to generate robust insights * Comfortable with ambiguity with the ability to challenge traditional thinking to solve problems * Exceptional communication and storytelling abilities * Executive presence and confidence in high-stakes presentations 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.

The Manager, Clinical Appeals (RN) leads the end-to-end clinical appeals function for both member and provider appeals, ensuring decisions are clinically sound, timely, defensible, and fully compliant with applicable federal, state, and accreditation requirements. This role oversees RN reviewers and clinical staff, manages vendor/peer review workflows, and partners cross-functionally (Medical Directors, Compliance, Legal, UM, Customer Service) to optimize outcomes, reduce overturn rates, and deliver an excellent member and provider experience. Key Responsibilities Operational Leadership * Manage day-to-day operations of the clinical appeals team (RN reviewers, coordinators), including staffing, workload distribution, case assignment, and escalation management. * Ensure timely completion of appeals within regulatory and contractual turnaround times for all lines of business. * Oversee the clinical development of appeal rationales, including appropriate application of medical necessity criteria, plan policies, and evidence-based guidelines. * Coordinate independent review organization processes and file preparation for external review entity processing. Regulatory & Compliance Oversight * Own and maintain workflows that comply with CMS (Medicare Parts C/D), applicable state regulations, ERISA, and NCQA standards as applicable. * Monitor regulatory changes; update policies, procedures, templates, and training materials; communicate changes and implementation timelines to staff. * Partner with Compliance teams on audits, corrective action plans, and risk mitigation; lead responses to internal/external audits and regulators. * Enforce HIPAA and privacy/security requirements across all appeal activities. Quality & Performance Management * Track and regularly report on KPIs inclusive of: timeliness compliance, uphold and overturn rates, volumes, audit findings, mitigation strategies. * Oversee teams conducting quality reviews of clinical case files, rationales, and decision letters; implement coaching and targeted remediation. * Perform root cause analysis on overturns, grievances linked to appeals, and external review outcomes; drive process improvements with UM, Care Management, and Provider Relations. * Participate in the development of training curricula, competency assessments, and continuing education for RN reviewers and staff. Cross-Functional Collaboration & Communication * Serve as the clinical appeals subject matter expert (SME) for internal stakeholders and external partners, including regulators and accreditation bodies when necessary. * Collaborate with Medical Directors on complex cases, medical necessity criteria interpretation, and clinical policy alignment. * Partner with Provider Relations to address provider concerns and reduce recurrent appeal drivers; support clinical education and feedback loops. * Draft and/or approve member and provider decision communications to ensure clarity, completeness, and compliance with regulatory content requirements. Technology, Data, & Vendor Management * Optimize use of appeal platform and integration with organizational systems * Manage relationships and performance with IROs, peer review vendors, and delegated entities; oversee service-level agreements and quality metrics. * Leverage analytics to identify trends, forecast volumes, and inform staffing and process changes. Required * Active, unrestricted RN license in PA or NJ. * Bachelor's degree in Nursing (BSN) * 5-7+ years of experience in utilization management, case management, clinical appeals, or related clinical operations within a health plan or integrated delivery system. * 2-3+ years of leadership or supervisory experience managing clinical staff inclusive of RNs. * Demonstrated expertise with medical necessity criteria, evidence-based guidelines, and health plan clinical policy application. * Solid knowledge of regulatory frameworks governing appeals including: CMS, PA and NJ State regulations, ERISA, and NCQA standards. * Experience managing audits, remediation, and corrective action plans. * Strong documentation and writing skills for clinical rationales and decision letters. * Proficiency with care management/appeals platforms and MS Office. Preferred * Master's in Nursing, Healthcare Administration, Public Health, or related field. * Prior experience with delegation oversight, vendor management, and external review case preparation. * Familiarity with Medicare Parts C/D and pharmacy appeals workflows. 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.

The Member Retention team is dedicated to creating a positive experience for our Medicare Advantage and Medicare Supplement members. We achieve this by developing compelling, informative, and compliant materials that educate, engage, and build trust - helping members feel confident in their healthcare choices and encouraging continued enrollment. Co-op Job Description: The Core Marketing Analyst Co-op will support the Member Retention team in the development and review of marketing and mandatory materials. This includes ensuring compliance with CMS Medicare Marketing guidelines, maintaining brand standards, and assisting with digital campaign setup and tracking. The role offers hands-on experience in healthcare marketing, compliance, and member engagement strategy. Key responsibilities may include (but are not limited to): * Creating and updating mandatory materials to support member retention * Editing and reviewing marketing and compliance documents * Routing materials through internal review and approval processes * Ensuring alignment with CMS Model documents and brand standards * Assisting with digital campaign setup, tracking, and reporting Required Skills and Qualifications The ideal candidate will demonstrate: * Strong professionalism, communication, and collaboration skills * Excellent verbal and written communication abilities * Strong organizational and time management skills * Proficiency in Microsoft Office Suite (Excel, Outlook, PowerPoint) * Customer service mindset and a team-oriented attitude * Attention to detail and problem-solving abilities Accepted Majors: * Business Administration * Marketing * Public Health * Healthcare Management * Communications Classification: * Senior * Recent graduate (within one year of program start date) GPA Requirement: 3.2+ and higher 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.

We are seeking a highly skilled and motivated Lead EDI Analyst to join our EDI Business Operations team. This role is responsible for managing, processing, and optimizing Electronic Data Interchange (EDI) workflows that support payer-side healthcare transactions. Key responsibilities include oversight of transactions such as Eligibility Benefit Inquiry/Response (270/271), Claim Status Request/Response (276/277), Claims Acknowledgement (277CA), Authorization Request/Response (278), Claims (837I/837P/837D), Electronic Remittance Advice (835), and Implementation Acknowledgement (999), spanning multiple lines of business. The Lead EDI Analyst drives key initiatives to enhance claims processing, eligibility verification, and payment accuracy, while ensuring full compliance with HIPAA regulations and industry standards. This role is central to optimizing healthcare data exchange and supporting operational excellence across the organization. We're looking for a detail-oriented, analytical professional who thrives in a collaborative environment and is passionate about continuous improvement and innovation. The ideal candidate will lead efforts to deliver scalable, efficient EDI solutions that strengthen our internal systems and external partner communications. As a member of our EDI team, the Lead Analyst will contribute to maintaining the integrity and efficiency of our operations. We value teamwork, proactive problem-solving, and empowering our employees to lead with purpose and impact. Responsibilities include, but are not limited to: * Proactively monitor and analyze production EDI activity to ensure data quality, accuracy, and compliance with mapping specifications, regulatory requirements, industry standards, performance benchmarks, and internal policies. * Continuously monitor system health throughout the day to support real-time EDI transactions and minimize disruptions * Work closely with internal stakeholders to support accurate and timely EDI file processing * Engage in cross-functional collaboration with internal business and IT teams, along with external partners and vendors, to resolve issues and guarantee smooth EDI operations * Coordinate with Trading Partners, Account Teams, Providers, and Claims Teams to identify, troubleshoot, and resolve EDI-related issues efficiently * Lead EDI initiatives, including new implementations and system upgrades, ensuring timely execution and alignment with business goals * Facilitate stakeholder engagement throughout the project lifecycle, maintaining clear communication, accountability, and collaboration across internal teams and external partners * Define and document business requirements and mapping specifications for electronic data exchange, ensuring seamless integration between client and internal systems * Participate in requirement review sessions with stakeholders, subject matter experts, and trading partners to validate business needs * Maintain clear documentation and workflows for EDI changes and mapping updates using Microsoft Word, Excel, PowerPoint, and Visio * Collaborate with the Testing Team to design and execute comprehensive test plans and scenarios for defect resolutions, system enhancements, and project initiatives * Support end-to-end testing and validate results through detailed review and approval * Coordinate testing activities with external vendors to ensure alignment, quality, and timely execution of deliverables * Provide support for production checkout and monitor post-implementation defect tracking to ensure stability and performance * Identify and recommend process improvements to enhance operational efficiency and testing effectiveness * Perform additional responsibilities and tasks assigned to support team and organizational goals Qualifications * Bachelor's degree from an accredited institution preferred or equivalent work experience * 7+ years of experience in EDI transaction processing, preferably in a healthcare, managed care or insurance environment * Strong knowledge of HIPAA EDI standards (especially 270/271, 276/277, 277CA, 278, 837, 835, 999/TA1) * Experience with EDI tools, translators, and transaction monitoring systems * Excellent analytical, problem-solving, and communication skills * Demonstrated ability in planning, organizing, and executing tasks effectively * Ability to manage multiple priorities in a fast-paced environment * Strong working knowledge of Microsoft Office suite, including: * Excel: proficient in creating formulas, using VLOOKUPs, building pivot tables, and performing data analysis * Word, PowerPoint, and Visio: skilled in developing documentation, creating presentations, and mapping business processes Additional Preferred Experience: * Working knowledge of SQL to support defect analysis and resolution * Knowledge of BCBSA Blue Exchange transaction processing 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.

College Co-op - Corporate Accounting Analyst (MDV) About the Department: The Corporate Accounting Shared Services team is responsible for gathering, recording, analyzing, and interpreting financial information to support decision-making. The department ensures the accuracy of financial reporting on a monthly, quarterly, and annual basis, and provides leadership with insights to support strategic planning and business development. Co-op Job Description: Assignments will be tailored to the co-op's strengths and skills, and may include (but are not limited to): * Preparing journal entries for designated general ledger accounts * Reconciling general ledger accounts and performing routine inquiries and research to resolve variances * Completing tasks in accordance with company deadlines * Actively participating in monthly, quarterly, and annual close processes * Performing balancing reconciliations * Assisting accountants with schedule preparation and variance analysis * Responding to inquiries and requests related to assigned general ledger accounts * Supporting special projects involving general ledger accounts and accounting analysis Required Skills: The ideal candidate will demonstrate: * Strong written and verbal communication skills * Proficiency in Microsoft Office tools (Excel, Word, PowerPoint) * Strong organizational skills and attention to detail * Ability to stay focused and follow through on tasks * Effective time management skills * Completion of 2-3 accounting courses Accepted Majors: * Accounting * Finance Minimum GPA: * 3.3 or higher Independence Blue Cross is an Equal Opportunity and Affirmative Action 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.

The Director Medicare Sales effectively directs and manages the activities of the Medicare group retiree business to meet goals and strategic initiatives within Government Markets. Oversee the development, implementation and active monitoring of sales and retention strategies for Medicare. Continually monitor the marketplace and effectively communicate the needs of the staff to senior management. Oversee the hiring, developing and retaining of talented sales and support staff. Responsibilities: * Oversee the development, implementation and active monitoring of sales and/or retention strategies for Medicare. * Executes and meets all sales goals and strategic initiatives within the unit. * Ensures each member of the team understands and embraces the goals and initiatives. * Builds and manages internal and external relationships according to strategy and goals. * Directs the area's service responsibilities to ensure that the quality of the services being offered is in line with IBC's overall strategy. * Oversees and reviews all data submitted for the Sales Incentive program * Selects and develops staff, including coaching, counseling and directing to staff to promote efficiency and increase productivity and motivation. Works closely with the management team to encourage problem solving and the development of professional skills. * Directs cross-functional partners and sales team to ensure all tracking and reporting needed to drive business performance is in place * Develops sales pipeline to achieve year-over-year growth targets * Partners closely with Sales peers across the organization to ensure success * Represent the sales needs at interdepartmental meetings and committees. * Works with leadership to facilitate working relationships and accountabilities which achieve goals. * Ensures processes and procedures are documented. * Responsible for maintaining department budget. Prepare and submit budget for senior management review. Administer functional operations in accordance with budgeted goals and plans. * Performs other duties and special projects as assigned. Qualifications: * Bachelor's degree required or equivalent work experience in related field (master's degree preferred) * Minimum of 10 years' progressive Medicare experience with at least 5+ years managing sales channels. * Previous experience managing and motivating a staff to high levels of productivity required. * Demonstrated track record in achieving sales goals * Self-motivated, highly organized and detail oriented as well as above average problem solving, and analytical skills required * Excellent verbal and written communication skills required. * Strong interpersonal skills with the ability to develop and maintain strong working and business relationships. * Demonstrated ability to manage projects and customer expectations to a successful conclusion is essential. * Working knowledge of Microsoft Office Suite. * Active PA license in Health and Accident insurance * Candidates must have a valid driver's license and current auto insurance * Position requires travel 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.

The Operations Technology Sr. Business Systems Analyst will be responsible for oversight, development and expansion of multiple operational systems within the Operations Technology area. This role will collaborate across business areas and partner with Business Technology Services (BTS) to support Operations. Responsibilities: * Provides leadership for business analysis, planning and implementation initiatives; consulting with management and other functional areas to identify needs and resolve business problems. * Prioritize system issues. Work with BTS teams to document, track, and resolve. * Partner with teams from across the organization to understand business needs, understand how application capabilities can fulfill those needs, translate needs into requirements, and work with development team to see through to implementation. * Coordinate work with multiple teams with varying skill levels and business knowledge to achieve project development and implementation with a strategic view of interactions with other systems or business units to determine levels of impact; make recommendations for long- and short-term solutions. * Communicate system changes/enhancements/issues to end-user community. * Become system subject matter expert and provide training and support to end users as needed. * Coordinate daily administrative activities as well as testing and release/update support. * Perform other duties as assigned. Skills/Qualifications: * Bachelor's Degree in Business or IT preferred, or minimum 8+ years proven work experience in an Operations business unit necessary or equivalent technical experience required. * Excellent verbal and written communication and collaboration skills are required to covey complex ideas and concepts to users, team members and management. * Must be self-motivated, highly organized, and detailed oriented with demonstrated leadership skills and above average analytical skills with the ability to persuade, negotiate and resolve issues while maintaining project support. * Understanding of system design, multiple system integrations and analysis. * Knowledge of Operations processes and technologies is required, knowledge of project management tools, Agile, and business systems methodology preferred. * Product owner knowledge/experience preferred * Knowledge of the healthcare industry is a plus. 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.

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 well-being of the people and communities we serve. 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. Description A successful candidate in for the Fully Insured Group Billing Analyst role will exhibit proficiency in taking initiative, attention to detail, communication (verbal and written communication), process orientation, financial systems knowledge, team work and accountability. Specific duties include, but are not limited to: * Responsible for reviewing and processing invoices, and reconciling customer accounts. * Take ownership of the billing process and suggest improvements to the process * Perform Billing Account Maintenance, and Invoicing as directed by management. * Demonstrates willingness to step outside normal business tasks to improve processes and reduce financial risk. * Review and resolve invoice issues. * Interact with all internal and external partners across multiple related departments as needed. * Document specific customer issues (over/under payments, setup issues, etc.). * Escalate setup and billing issues to appropriate levels of management. * Coordinate with Senior, Lead and Supervisor on resolution of invoice errors. * Effectively resolve any issue as directed by Senior, Lead and/or management. * Identify, track, report trends and escalate issues to appropriate levels of management. * May perform other duties as required by management. Qualifications Knowledge Summary * Understanding of Billing, Finance, and Operations within the Healthcare industry. * Ability to think critically and resolve problems. * Strong attention to detail and the ability to succeed in a high paced environment. * Proficient with Microsoft Excel, Word, PowerPoint and Outlook. * Good written and verbal communication skills. * Ability to multi task and prioritize activities. * Detail oriented and organized, with exceptional prioritization skills. * Ability to effectively communicate with senior management, supervisors, peers and clients. * Customer Focused. Education & Experience * Bachelor's Degree in a Business-related field or equivalent work experience preferred. * Minimum 1 - 2 years working within a Billing, Finance or, Operations Department. * Billing experience in a Healthcare Industry preferred. * Must possess the ability to interface with internal and external customers at various levels. * Willingness to work in a fast-paced, challenging environment.