Claims Specialist

1 month ago


Philadelphia, United States Independence Blue Cross Full time
  • 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


Education

•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

  • Philadelphia, United States Crawford & Company Full time

    Position Summary The role of Content Claims Specialists is a multi-faceted role, which focuses primarily in the following four key areas of edjuster’s content claims handling operations: Acting/operating as a third party, intermediary between the Insurance Company's property adjusters, and their policyholders with respect to conducting valuations of...

  • Claims Specialist

    2 months ago


    Philadelphia, United States Independence Blue Cross Full time

    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...


  • Philadelphia, United States CHUBB Full time

    This role is focused on technical claim handling of . and international casualty claims. In this role you will learn to manage general liability, employer’s liability and auto claims. The individual will be accountable for the handling and disposition of claims including primary and excess coverage. Candidates will learn all facets of investigation,...


  • Philadelphia, United States BMS Re Full time

    About BMS BMS Group is a dynamic, independent global broker established in 1980, delivering specialist insurance, reinsurance, and capital markets advisory services. Our purpose is to help people, businesses and communities flourish and prosper in a world of risk. As a global brand with offices located across the US, Canada, Latin America, Australia, Europe...


  • Philadelphia, United States Global Force USA Full time

    Provider Enrollment Specialist Location : Philadelphia PA 19113 Contract: 3 months with possibility of extension Under the direct supervision of the Provider Enrollment Supervisor, the Provider Enrollment Specialist is responsible for maintaining both participating and non-participating provider records in the provider database, mapping...


  • Philadelphia, United States Global Force Full time

    Provider Enrollment Specialist Location : Philadelphia PA 19113 Contract: 3 months with possibility of extension Under the direct supervision of the Provider Enrollment Supervisor, the Provider Enrollment Specialist is responsible for maintaining both participating and non-participating provider records in the provider database, mapping claims in the...


  • Philadelphia, United States Global Force USA Full time

    Provider Enrollment Specialist Location : Philadelphia PA 19113 Contract: 3 months with possibility of extension Under the direct supervision of the Provider Enrollment Supervisor, the Provider Enrollment Specialist is responsible for maintaining both participating and non-participating provider records in the provider database, mapping...


  • Philadelphia, United States Global Force Full time

    Provider Enrollment Specialist Location : Philadelphia PA 19113 Contract: 3 months with possibility of extension Under the direct supervision of the Provider Enrollment Supervisor, the Provider Enrollment Specialist is responsible for maintaining both participating and non-participating provider records in the provider database, mapping claims in the...


  • Philadelphia, United States WAHVE LLC Full time

    P&C Commercial Claims Adjuster - Carrier or TPA - REMOTE Put your Insurance Experience to work - FROM HOME! At Wahve, we value significant insurance experience and want to revolutionize the way people think about phasing into retirement by offering qualified candidates the opportunity to continue their career working from home. As we say - retire from the...


  • Philadelphia, United States Chubb Full time

    ESIS ProClaim is seeking an experienced Senior Claims Specialist. In this role you will manage general liability claims and other lines. Key Objective This role is focused on the technical claim handling of professional Liability Casualty claims. In this role you will manage professional liability, general liability and product liability claims in multiple...


  • Philadelphia, United States GHR Search - General Healthcare Resources, Inc. Full time

    Exciting Opportunity: Senior Claims Adjuster Position at GHR Healthcare in Philadelphia PA! Join Our Team as a Senior Claims Adjuster! Pay: $35 -$43 hourly paid weekly (eligible for health insurance) Type: Hybrid Role (Contract to Hire Potential) Sch Insurance, Specialist, Clinic, Verification, Liability Adjuster, Healthcare, Staffing


  • Philadelphia, United States LA Inc Full time

    **About Us**: We are a dynamic healthcare organization committed to providing exceptional patient care and services. Our team is dedicated to improving the health and well-being of our community, and we are looking for a skilled Medical Coding and Billing Specialist to join our team in Philadelphia. **Job Title**: Medical Coding and Billing...


  • Philadelphia, United States Highlight Health Full time

    Job DescriptionJob DescriptionHighlight Health is a mission-driven company that protects consumer rights and controls healthcare costs for employer-funded health plans. We are a profitable, fast-growing company that does not accept private equity investments. Some healthcare claims can be repriced without engaging the patient directly, while others require...


  • Philadelphia, United States Highlight Health Full time

    Job DescriptionJob DescriptionHighlight Health is a mission-driven company that protects consumer rights and controls healthcare costs for employer-funded health plans. We are a profitable, fast-growing company that does not accept private equity investments. Some healthcare claims can be repriced without engaging the patient directly, while others require...


  • Philadelphia, United States Penn Medicine Full time

    **Description** Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all...

  • Appeals Specialist

    1 month ago


    Philadelphia, United States Blue Cross and Blue Shield Association Full time

    The Appeals Specialists investigates the appeal requests, gathers all pertinent information to ensure the appeals committee can provide an accurate and fair determination. Completes the determination letter and follows through with completing appeals within the specified compliance timeframe. * Thoroughly investigates and responds to written/verbal appeal...

  • Appeals Specialist

    2 weeks ago


    Philadelphia, United States Blue Cross and Blue Shield Association Full time

    The Appeals Specialists investigates the appeal requests, gathers all pertinent information to ensure the appeals committee can provide an accurate and fair determination. Completes the determination letter and follows through with completing appeals within the specified compliance timeframe. * Thoroughly investigates and responds to written/verbal appeal...


  • Philadelphia, United States Pennsylvania Medicine Full time

    Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines. Today at Penn...

  • Appeals Specialist

    1 month ago


    Philadelphia, United States Independence Blue Cross Full time

    The Appeals Specialists investigates the appeal requests, gathers all pertinent information to ensure the appeals committee can provide an accurate and fair determination. Completes the determination letter and follows through with completing appeals within the specified compliance timeframe. Thoroughly investigates and responds to written/verbal appeal...

  • Leave Specialist

    2 days ago


    Philadelphia, United States The Salvation Army Eastern Territory Full time

    Overview: **TITLE**: Leave Specialist **LOCATION/DEPARTMENT**:Divisional Headquarters, Human Resources Department **REPORTS TO: Directly**:Divisional HR Director**, Indirectly; **General Secretary*** **SUPERVISES**: Temporary staff and/or Interns, if applicable*** **SALARY and GRADE**: $30.00 per hour; 79 Non-Exempt **STATUS**:Full-time **SCHEDULE**: 40...