Blue Cross & Blue Shield jobs in Philadelphia, PA

* 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. * Bachelor's degree in business operations or equivalent work experience * More than two years working in an operations environment. * Knowledge of claims processing preferred. * Previous experience in Reinsurance or Stop Loss/Healthcare experience preferred. * Experience working in a production driven environment. * Self-starter, highly motivated problem solver with the ability to work independently. * Ability to multi-task and handle deadline driven assignments. * Ability to perform appropriate research, make responsible decisions and demonstrate customer-oriented professionalism. * Strong organization skills and attention to detail capabilities are required. * Strong communication and competency skills are necessary. * Ability to follow documented procedures and instructions. * Cross-functional team collaboration abilities are 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.

The Vice President - Chief Accounting Officer (CAO) is a senior accounting and tax leadership role in a high-growth, private health insurance company. This position is responsible for delivering timely and accurate financial reporting that meets public company standards, supporting both legal entity and consolidated level reporting on GAAP and statutory bases, and overseeing all associated federal and state tax provisions and filings. The CAO leads strategic initiatives, drives process efficiency through technology, and ensures strong technical expertise across the team. The role requires exceptional communication and influencing skills, working internally at all levels and externally with key stakeholders. Key Responsibilities: Plan and lead all aspects of the Accounting and Corporate Tax functions for Independence Health Group and its subsidiaries, ensuring timely, accurate, and meaningful financial information for senior management in accordance with GAAP, Statutory Accounting and Tax requirements. Accounting and Financial Reporting - * Oversee financial reporting, including GAAP, statutory, regulatory, and tax reporting, and provide technical accounting and tax guidance for all companies. Represents finance at subsidiary board meetings and reports on legal entity results as well as presenting results in various forums throughout the company. * Lead technical accounting research and advise senior leadership on accounting, finance, and strategic initiatives. * Ensure compliance with all financial statement reporting requirements as well as BCBSA and company policies. * Own and maintain an enterprise control environment, inclusive of the balance sheet monthly account reconciliation process and related exposures, to ensure complete and accurate financial statements for each legal entity and consolidated group. * Ensure compliance with all relevant regulatory requirements and proactively engage with regulatory bodies to address emerging risks and maintain the organization's reputation for integrity and transparency. * Lead and/or support coordination of external audit engagements and partner with Internal Audit for control and compliance areas such as Model Audit Rule (MAR), Enterprise Risk Management (ERM), and Own Solvency Risk Assessment (ORSA). Tax Strategy and Compliance - * Develop and lead overall corporate tax strategy, organizing and managing the tax function to minimize federal, state, and local taxes. * Oversee tax planning for mergers, acquisitions, and divestitures. * Direct external tax consultants and manage relationships with public accounting and tax counsel. * Recommend and implement changes in corporate structure, policies, and practices to reduce taxes and audit risks, including negotiation and resolution of tax controversies. * Ensure all tax-related provisions/reserves are adequate, accurate, substantiated and reconciled to support external IRS or other external audits/reviews. * Conducts negotiations and resolves issues with various taxing authorities including administrative appellate proceedings and settlement of tax controversies, including management of activities related to tax litigation. * Stay abreast of legislation and regulations affecting corporate taxation. Technology Leadership and Transformation - * Champion the adoption of innovative technologies and digital solutions to enhance accounting and tax operations. * Continuously evolve business practices to ensure further process automation, data analytics, and the integration of cloud-based financial systems to improve accuracy, efficiency, and scalability. * Collaborate with IT and business partners to evaluate and implement new tools that support strategic objectives. Finance Partnerships and Strategy - * Actively contribute to the development and execution of business strategies, ensuring alignment between financial objectives and organizational goals. * Serve as a key advisor to the CFO and executive leadership team, providing insights and recommendations that inform enterprise-wide financial planning, scenario modeling, and strategic decision-making. * Build and maintain strong relationships with external stakeholders, including auditors, rating agencies, regulators, and industry associations. * Represent the company in professional forums and with the BCBSA ensuring effective communication of financial results, strategic initiatives, and compliance matters to all relevant parties. Talent Development - * Foster an inclusive and equitable work environment by promoting diversity in hiring, development, and advancement practices. * Champion initiatives that support a culture of belonging and ensure all team members have opportunities for growth and contribution. * Recruits, retains and develops talented professionals. Fosters a culture of continuous professional development and growth. * Develop and execute succession plans for key accounting and tax roles, ensuring a robust talent pipeline. Mentor and coach emerging leaders, providing opportunities for professional development and preparing the organization for future leadership needs. * BA/BS in Accounting; MBA, MS in Taxation strongly recommended * CPA with active license strongly recommended * Fifteen (15) or more years of experience in increasingly responsible financial management positions culminating in a senior financial position in the health insurance industry. * Proven leader with skills to recruit, retain, reinforce and motivate strong teams. Public accounting experience with a big four firm preferred. * Track record of success as a financial leader, setting direction for, developing and managing a full range of human, financial and operational resources needed to achieve success; strong leadership and inter-personal skills. * Expert knowledge of FASB, GAAP & statutory accounting principles; strong technical tax and accounting, analytical and problem-solving skills along with attention to detail. * Ability to anticipate accounting, financial reporting, tax and operational issues, assess implications, determine impact and develop and implement an appropriate action plan. 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 Government Markets Product Team oversees the annual product portfolio lifecycle, including the design and implementation of core medical, Part D, and supplemental benefits. The team collaborates with internal and external stakeholders to ensure operational readiness for January 1 launches and manages the CMS application and bid submission process to maintain compliance across the PA5 and NJ7 service areas. Co-op Job Description: The Product Analyst Co-op will support the team throughout the product lifecycle - from initial concept development to implementation - in preparation for Annual Enrollment Period (AEP) readiness. This role involves cross-functional collaboration to ensure product and market needs are met, and includes tasks such as competitive assessments, bid preparation and review, product grid maintenance, marketing support, and regulatory analysis. Key responsibilities may include (but are not limited to): * Assisting with product development and implementation activities * Supporting competitive market assessments and bid preparation * Maintaining product grids and documentation * Participating in marketing material reviews * Reviewing and analyzing regulatory requirements related to plan benefits * Collaborating with internal teams to ensure compliance and operational alignment 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 * Problem-solving skills and attention to detail Accepted Majors: * Business Administration * Marketing * Public Health * Healthcare Management Classification: * Senior * Recent graduate (within one year of program start date) GPA Requirement: * 3.5+ and higher Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.

Supervisor FEP Claim Operations The Supervisor of Claims Operations supervises daily activities of specific market segment unit (FEP) and ensures accurate and timely processing of all claims and post payment adjustments. Oversees review of claims for benefit determination, other party and subscriber liability. Supervises examiners/analysts in providing prompt and accurate information and courteous service to all internal and external customers. Responsibilities * Plans, controls, coordinates daily workflow, maintaining high rate of quality and productivity without excessive overtime * Supervises examiners/analysts in the accurate and timely processing of medical claims and all related procedures. Supervises processing of necessary adjustments on paid claims. Maintains an effective, on-going quality control program and ensures that all operational standards of performance established by the account, our Plan, Blue Cross and Blue Shield Association, etc., are met. * Ensures that prompt, accurate information and courteous service is provided to all internal and external customers via all forms of communication. * Prepares production reports for management. Maintains accurate and current records of all claims and inquiries received, processed, and pended. * Reviews work procedures, work output and automated programs to detect problem areas and opportunities for improvement. Initiates and/or assists with projects and procedural changes affecting the specific workstream, including major system changes to maintain and enhance the efficient processing of claims. Makes recommendations and develops and implements new or revised methods or procedures. * Monitors performance of subordinates, working to develop and enhance their skills. Administers corrective action in accordance with policy when appropriate. * Performs other appropriate duties as assigned. Qualifications Education * Undergraduate degree, preferably in Business Administration, in addition to a minimum of 3 years of supervisory experience. In lieu of the degree, a minimum of 5 years of similar leadership experience within an operations environment is required. Experience * 5 years FEP claims processing or related experience is required * Prior experience should include a minimum of 2 years work leadership responsibility in claims or related operations Knowledge, Skills, Abilities * Required: Experience with FEP Claims Processing and FEPDirect * Demonstrated ability in organizing and controlling workflows * Proven understanding of COB/OPL coordination rules * Excellent oral and written communication skills and the ability to complete assignments with minimal guidance. * Strong Analytical ability to identify and resolve staff and customer problems. * Must be able to prioritize work in an environment that changes frequently. 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.

The Business Systems Support Administrator position is customer facing position, responsible for supporting and implementing strategies and initiatives geared toward promoting increased utilization of Provider Portal transactions - either through the deployment, training and promotion of existing functionality, development/implementation and promotion of enhancements to existing functionality or the development/implementation, training and promotion of new functionality - to facilitate improved transactional efficiency, reduce administrative costs and improve provider satisfaction with processing performance. MAJOR ACTIVITIES: 1. Ensures provider portal issues reported from key intake channels (ServiceNow, L2 PEAR Production Support, Provider Network Services, etc.) are reviewed, logged, and assigned. 2. Researches, troubleshoots and either resolves or identifies a path to resolve issues submitted by providers either via emails or phone calls. 3. Assist with provider portal registration, deployment, and provisioning activities. 4. Provides provider training by either referring them to training documents or providing hands on verbal/visual training on how to use the system and conducts walk-throughs on how to complete a transaction in the system. 5. Supports provider outreach campaigns. Conducts outreach calls to notify providers of platform changes and any revised logon procedures. 6. Recommends process improvements to management to enhance the provider experience. 7. Develops and maintain positive working relationships with external customers, vendors, and other functional areas. 8. Performs other duties as assigned. 1. Bachelor's degree in computer technology, business administration, health administration or related field field/equivalent experience. 2. 3-5 years relevant experience in a managed care setting. 3. Proficiency with Microsoft Office Products: Word, Excel, and PowerPoint. 4. Strong analytical skills, attention to detail as well as strong oral, written, interpersonal and presentation skills. 5. Ability to self-start, self-motivate and work independently, as well as the ability to adjust priorities as 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.

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. Senior Operations Specialist is responsible for: * Auditing, analyzing, testing, documenting decisions and actions, and interfacing with internal and external areas from inception to conclusion for assigned projects and tasks. * Identify & communicate opportunities for process improvements and automation by analyzing current policies, procedures, and processes. * Troubleshooting & problem resolution support for issues related to internal & external audits, adjustments, and accumulators, engaging subject matter experts, as needed. * Makes decisions based on standard policies and operating procedures. * Consults with management and obtains approval before deviating from standard policies and operating procedures. * Has working knowledge and experience in own discipline. * Continues to build knowledge of the organization, processes and customers. * Performs a range of mainly straightforward assignments. * Uses prescribed guidelines or policies to analyze and resolve problems. * Receives a moderate level of guidance and direction from more senior level roles. 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 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.

* 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.

The Sr. Business Systems Support Administrator position is customer facing position, responsible for supporting and implementing strategies and initiatives geared toward promoting increased utilization of Provider Portal transactions - either through the deployment, training and promotion of existing functionality, development/implementation and promotion of enhancements to existing functionality or the development/implementation, training and promotion of new functionality - to facilitate improved transactional efficiency, reduce administrative costs and improve provider satisfaction with processing performance. Assist with the implementation of system fixes and enhancements, conduct system testing activities, and support the communication plan to notify internal and external users. MAJOR ACTIVITIES: 1. Ensures provider portal issues reported from key intake channels (ServiceNow, L2 PEAR Production Support, Provider Network Services, etc.) are reviewed, logged, and assigned. 2. Researches, troubleshoots and either resolves or identifies a path to resolve complex issues submitted by providers either via emails or phone calls. 3. Supports provider portal registration, deployment, and provisioning activities by assisting providers with gaining system access. 4. Provides provider training by either referring them to training documents or providing hands on verbal/visual training on how to use the system and conducts walk-throughs on how to complete a transaction in the system. 5. Supports provider outreach campaigns. Conducts outreach calls to notify providers of platform changes and any revised logon procedures. 6. Collaborates with other business areas to assist with resolution of provider portal issues. 7. Assists management with the preparation of workflows and in writing provider communications, e-reference guides, and internal documentation/desk procedures as needed. 8. Provides UAT support for system fixes and upgrades working with team Lead Business Systems Analysts, technical support teams, and external vendors. 9. Develops and maintain positive working relationships with external customers, vendors, and other functional areas. 10. Performs other duties as assigned. 1. Bachelor's degree in computer technology, business administration, health administration or related field field/equivalent experience. 2. 5+ years progressive experience in a managed care setting. 3. Proficiency with Microsoft Office Products: Word, Excel, and PowerPoint. 4. Strong analytical skills, attention to detail as well as strong oral, written, interpersonal and presentation skills. 5. Ability to self-start, self-motivate and work independently, as well as the ability to adjust priorities as 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.

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.

About the Department: The Accounts Payable department is responsible for the accurate processing and reconciliation of payments to providers, members, groups, and vendors. Co-op Job Description: The Accounts Payable Co-op will support daily operations by assisting with inquiries, researching payment issues, and contributing to both recurring tasks and ad-hoc projects. This role offers hands-on experience in financial operations and exposure to cross-functional collaboration. Key responsibilities may include (but are not limited to): * Respond to internal and external customer inquiries via email and inquiry systems. * Research and resolve address discrepancies; update information in the payment system. * Investigate and document returned claims. * Support recurring operational tasks and assist with special projects as assigned. Required Skills and Qualifications: The ideal candidate will demonstrate: * Strong analytical and problem-solving abilities * Effective written and verbal communication skills * Ability to manage multiple priorities in a fast-paced environment * Proficiency in Microsoft Office Suite (Excel, Word, Outlook) * Ability to work both independently and collaboratively in a team setting * Self-starter with a proven ability to meet deadlines * Excellent organizational and time management skills Accepted Majors: * Business Administration * Finance Classification: * Junior * Senior * Recent graduate (within one year of the program start date) GPA Requirement: * 3.2+ 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.

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. Job Description: We are seeking a dedicated Actuary to join our Actuarial Services team, focusing on Health Value Optimization. This role involves critical analysis and support of vendor contracts, ensuring these align with our strategic goals in health value optimization. The successful candidate will play a key role in influencing how our contracts contribute to the overall value and efficiency of healthcare delivery. Key Responsibilities: * Analyze and evaluate vendor contracts with a focus on Health Value Optimization, financial implications, and risk assessment. * Apply advanced actuarial techniques to model and forecast the impact of vendor contracts on healthcare costs and quality. * Collaborate with Provider Contracting, Vendor Management, and Clinical Care Innovation teams to ensure contracts support value-based care objectives. * Lead the assessment of vendor proposals from a health value optimization perspective, ensuring alignment with company's strategic goals. * Contribute to the development and refinement of value-based and pay-for-performance models in vendor contracts. * Provide actuarial insight in negotiations to maximize health value and cost-effectiveness of vendor agreements. * Ensure compliance with relevant regulations and standards, particularly those related to value-based healthcare. * Communicate complex actuarial analyses and strategies to internal and external stakeholders. Qualifications: * Bachelor's degree in Actuarial Science, Mathematics, Statistics, or related field. * Fellow or Associate of the Society of Actuaries (SOA) or similar professional body. * Demonstrated experience in health insurance or related field, with a focus on health value optimization. * Strong understanding of healthcare economics, value-based care, and vendor contract structures. * Proficient in actuarial software and tools (e.g., SAS, SQL, R) and their application in health value analysis. * Excellent analytical, negotiation, and communication skills, with the ability to articulate the value proposition of complex actuarial strategies. At Independence Blue Cross, 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.

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.

The Medicare Broker Sales team drives enrollment growth through strategic partnerships with licensed insurance brokers and agencies. The department manages broker relationships, delivers training and support, ensures compliance with CMS guidelines, and develops targeted sales strategies to promote Medicare Advantage plans. By leveraging market insights and fostering strong collaborations, the team plays a vital role in expanding access to Medicare coverage and enhancing member acquisition. Co-op Job Description: The Medicare Sales Analyst Co-op will support the day-to-day operations of the broker sales channel. This includes assisting with marketing efforts, sales analytics, broker event coordination, and strategic planning. The role offers hands-on experience in a fast-paced, mission-driven environment focused on improving healthcare access for Medicare beneficiaries. Key responsibilities may include (but are not limited to): * Supporting broker marketing initiatives and campaign execution * Assisting with data analysis and sales performance reporting * Coordinating logistics for broker events and trainings * Contributing to strategic planning and goal tracking * Collaborating with internal teams to support broker engagement * Ensuring compliance with CMS and internal policies Required Skills and Qualifications The ideal candidate will demonstrate: * Strong verbal and written communication skills * Excellent organizational and time management abilities * Proficiency in Microsoft Office Suite (Excel, Outlook, PowerPoint) * Familiarity with CRM systems (e.g., Microsoft Dynamics) is a plus * Attention to detail and ability to manage multiple priorities * Customer service mindset and a collaborative, team-oriented attitude Accepted Majors: * Business * Marketing * Healthcare Administration Classification: * Senior * Recent graduate (within one year of 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.

We are looking for a detail-oriented individual with Account Receivable and Collection experience who will take full ownership of the Consumer Accounts Receivable position Applicant will be responsible for tracking and resolving outstanding payment issues and process monthly aging reports in a timely manner. The candidate must have knowledge of general accounting principals and MS Office (especially Excel). The applicant should display a positive and proactive attitude, strong organizational skills, the ability to prioritize and multitask and be a strong communicator, both paper and email. Some of the responsibilities include: * Conduct accounts research and analysis * Prepare and maintain various reports * Maintain aging report * Identify and execute necessary account adjustments * Conduct QA of Analyst adjustments in different systems * H.S. diploma required - some college course work is preferred. * Customer Service experience working in a fast-paced environment. Health insurance or retail collections experience is preferred. * Finance background that encompasses the ability to understanding account aging. * Desire to be part of a high-performing team that has significant impacts to cash and client account status. Team focus is a top priority. * Strong proficiency in Microsoft Excel. * Excellent written and verbal communication skills. * Excellent analytical skills * Ability to help solve complex account issues. 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: Product Services Analyst (J.F.) The Product Services team supports plan inventory management through the Product Configurator application and related data entry. The department also develops templates for booklet and contract production, contributing to efficient and accurate product documentation. Co-op Position Description: The Product Services Co-op will primarily support the Product Configurator team during peak periods, with additional responsibilities assisting the Booklet & Contract Development team on automation-related projects. This role offers exposure to both technical and business-facing aspects of product configuration and documentation. Key functions and responsibilities of the department include: * Participate in discovery discussions for Change Requests * Translate business discussions into functional specifications * Execute application model changes within the Product Configurator * Perform quality assurance (QA) testing * Support system and data analysis in preparation for a Product Configurator upgrade * Assist with automation initiatives and special projects as needed Required Skills & Qualifications: The ideal candidate will demonstrate: * A solid understanding of Boolean logic * Some programming experience (JavaScript preferred; proficiency not required) * Familiarity with the Software Development Life Cycle (SDLC) and Agile methodology * Ability to communicate technical concepts to non-technical stakeholders * Proficiency in Microsoft Office tools, especially Excel and SharePoint * Strong analytical and problem-solving skills * Excellent verbal and written communication skills Accepted Majors: * Computer Science * Computer Engineering * Information Technology Classification: * Junior or Senior undergraduate students * Recent graduate (within one year of the program start date) Minimum GPA: * 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.

Self-Funded Billing Analyst The Self Funded Billing Analyst is responsible for the billing, account maintenance, and collection of accounts receivable for a portfolio of self funded customers. This position works closely with internal finance and marketing partners and with our self-funded groups or their consultant. The Billing Analyst will be responsible for the following: * Detailed preparation of Self Funded customer invoices, customer setup, accounts receivable reconciliations, and aging results. The 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. * Basic understanding of the Self Funded Billing Processes. * Collaborates with internal partners and demonstrates ability to work with internal and external customers. * Demonstrates ability to communicate at both a technical and business level; able to explain all customer related activity including issues and potential root causes. * Responsible for ensuring the assigned portfolio of customer accounts are maintained and reconciled on a weekly and monthly basis. * Prepares results of annual customer account Settlements/Reconciliations. * Responsible for running standard Production reports and Ad Hoc reports as needed. * Follows all key internal controls and supports audits and variance inquiries as required; prepares/reconciles control totals. Qualifications: * Minimum 1 - 3 years working within a Billing, Finance or Operations Department. * Bachelor's degree in Accounting, Finance, or related area of study preferred. * Billing experience in a Healthcare / Insurance Industry preferred. * Proficient with Microsoft Excel, Word, and Outlook. Knowledge of SQL, Access, and Adobe. Standard. Having knowledge of Web based applications and having PeopleSoft is a plus. * Demonstrated ability prioritizing and multi-tasking, * A successful candidate in this role will exhibit proficiency in the following competencies: initiative, attention to detail, communication (verbal and communication), process orientation, and financial systems knowledge 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 Quality Business Analyst works collaboratively with various business areas to ensure compliance with established metrics and adherence to company policies and procedures. Through auditing, the analyst identifies areas for improvement, system inconsistencies, and training opportunities to enhance operational excellence, ultimately supporting the delivery of high-quality service to our clients and members. Key Responsibilities: * Review operational activities end-to-end to ensure accuracy and completeness. * Provide timely documented feedback on issues identified at the processor and/or system level and initiate escalation procedures when necessary. * Work collaboratively with the business areas to identify areas of improvement and opportunities for efficiencies. * Audit operational transactions, including Enrollment, Billing, Claims, Appeals and Client Setup, ensuring adherence to departmental policies and procedures. * Review end-to-end operational activities to verify compliance with internal standards and regulatory requirements. * Provide timely, documented feedback on issues identified at the processor and/or system level, and initiate escalation procedures when necessary. * Identify process improvements and develop workflow and/or system recommendations for operational efficiencies. * Perform analysis to identify trends and detect root causes of deficiencies, supporting continuous improvement initiatives. * Design and execute test plans for new or modified processes, ensuring changes function as intended and comply with policies and regulations. Maintain detailed testing notes and documentation. * Communicate effectively, both in writing and verbally, with internal and external teams. * Support assigned projects, maintain documentation at the task level, monitor deadlines, and serve as a technical liaison when appropriate. * Attend internal and external training to maintain proficiency on all systems and processes. * Perform other duties as assigned. * Minimum 3 to 5 years of quality review, auditing, or claims processing experience. * Bachelor's Degree preferred. * Demonstrated self-starter with strong problem-solving, attention to detail, analytical, organizational, and writing skills. * Knowledge of systems, process flows and timelines to ensure requirement testing and implementation are compliant across operational disciplines. * Ability to compile detailed system requirements, reporting and data mining to support business needs. * Skilled in trend analysis and highly effective in communicating as the liaison with business partners on findings and recommendations focused on minimizing impacts to other areas and the customer. * Superior written and verbal communication skills are required to provide business partners with information and tools to support system modifications and/or new implementations. * Maintain flexibility in a team environment and identify process improvement opportunities and define system impacts that may result. * Working knowledge and experience with healthcare plans, claims processing, client setup, enrollment, and other operational areas. * Foundational knowledge of systems including, Front Office System (FOS), Health Rules Payor (HRP), H3O, ORMB, Service Now (SNOW). * Ability to effectively work autonomously in a hybrid environment. Must be in the office 3 times per week (Tuesdays, Wednesdays, Thursdays). 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.