Claims Resolution Specialist

3 weeks ago


Philadelphia, Pennsylvania, United States Independence Blue Cross Full time

At Independence Blue Cross, we are seeking a highly skilled Claims Resolution Specialist to join our team. This role is responsible for accurately 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.

The ideal candidate will have a proven track record of resolving complex claims and possess excellent analytical and problem-solving skills. They will also have the ability to work independently and as part of a team to meet departmental quality and production requirements.

The Claims Resolution Specialist will be responsible for:

  • Researching and adjusting complex and/or high dollar adjustment requests received from all areas, inclusive of internal and external sources.
  • Handling FEP reconsiderations accurately and timely per the FEP benefit manuals and guidelines.
  • Meeting departmental quality and production requirements.
  • Responding professionally to external/internal inquiries, as appropriate, while maintaining corporate and departmental standards.

The successful candidate will have a high school graduate or equivalent work experience, with at least 5 years of proven work experience in a production environment. They will also possess excellent math and comprehension skills, as well as good interpersonal skills for handling internal and external customers.

Additionally, the Claims Resolution Specialist will have proficiency with Microsoft Office, specifically Excel and Word, and the ability to research and investigate information using multiple sources, operating systems and documented guidelines.

Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. We are committed to diversity and inclusion in the workplace.



  • Philadelphia, Pennsylvania, United States GB Group, LLC Full time

    Claims Resolution OpportunityGB Group LLC is seeking a skilled Claims Resolution Specialist to manage liability, physical damage, and cargo claims. If you have experience handling complex claims, we want to hear from you.Key Responsibilities:· Manage liability, physical damage, and cargo claims with precision and accuracy.· Utilize strong communication and...


  • Philadelphia, Pennsylvania, United States Pennsylvania Medicine Full time

    Penn Medicine is dedicated to delivering exceptional patient care, conducting innovative research, and educating future healthcare leaders. As a leading academic medical center, we collaborate with top professionals across all disciplines to provide the highest level of care.At Penn Medicine, our employees play a vital role in shaping our future every day....

  • Claims Specialist

    4 weeks ago


    Philadelphia, Pennsylvania, United States RG2 Claims Administration LLC Full time

    Job OverviewRG/2 Claims Administration LLC is seeking a highly skilled Claims Analyst to join our team. As a Claims Analyst, you will be responsible for handling settlement agreement analysis, data entry of claimant information, claim review, data management and analysis, report processing and reconciliation, claim payment distribution activities, and...


  • Philadelphia, Pennsylvania, United States Pennsylvania Medicine Full time

    Penn Medicine is a leading academic medical center dedicated to delivering exceptional patient care, conducting innovative research, and educating future healthcare leaders.As an Accounts Resolution Specialist I, you will play a critical role in facilitating the resolution of accounts, working closely with top clinical, technical, and business professionals...


  • Philadelphia, Pennsylvania, United States Independence Blue Cross Full time

    At Independence Blue Cross, we are seeking a highly skilled and detail-oriented Issue Resolution Specialist to join our team. This critical role is responsible for receiving, investigating, and resolving State Based Exchange tickets in a timely and accurate manner.Key Responsibilities:Manage and monitor caseload daily to ensure tickets are researched,...


  • Philadelphia, Pennsylvania, United States Pennsylvania Medicine Full time

    Job SummaryPenn Medicine is seeking a highly skilled Accounts Resolution Specialist to join our team. As a key member of our revenue cycle team, you will be responsible for resolving patient accounts, investigating claim edits, and working with insurance carriers to obtain payment.ResponsibilitiesInvestigate and resolve patient accounts, including claim...


  • Philadelphia, Pennsylvania, United States North Star Chevrolet Full time

    Warranty Claims SpecialistWe are seeking a highly motivated Warranty Claims Specialist to join our accounting and finance team at NorthStar Auto.As a Warranty Claims Specialist, you will play a vital role in ensuring the smooth operation of our warranty processes and procedures.This is a full-time position with a base salary and commission structure,...

  • Claims Specialist Sr

    3 weeks ago


    Philadelphia, Pennsylvania, United States Munich Re Full time

    We are seeking a highly skilled Senior Claims Specialist to join our Financial and Professional Lines Core team. This critical role will be responsible for directing all aspects of file handling on both in-house and third-party administered property claims.The Senior Claims Specialist will analyze and determine coverage, manage the claim investigation,...


  • Philadelphia, Pennsylvania, United States CHUBB Full time

    Senior Claim Specialist - Life SciencesChubb is seeking a highly skilled Senior Claim Specialist to join our Life Sciences Claims team. As a key member of our team, you will be responsible for handling complex claims related to medical products and instruments. Your expertise will be essential in providing exceptional customer service and ensuring that...


  • Philadelphia, Pennsylvania, United States Cozen O Connor Full time

    Job SummaryWe are seeking a skilled Recovery Claims Specialist to join our team at Cozen O'Connor. The ideal candidate will have experience in property claims and be able to review complex subrogation claims to determine viability or closure.Key ResponsibilitiesReview and analyze subrogation claims to determine viability or closureMonitor and negotiate...

  • Claims Apprentice

    4 weeks ago


    Philadelphia, Pennsylvania, United States PMA Companies Full time

    Claims Apprentice ProgramThe Claims Apprentice Program is an exciting opportunity for recent college graduates to launch their career as a Claims Adjuster in the Property & Casualty insurance industry.Job Responsibilities:Investigate assigned claims to determine coverage, compensability, and potential for subrogation recovery.Ensure timely denial or payment...

  • Claims Manager

    4 weeks ago


    Philadelphia, Pennsylvania, United States Enviri Corporation Full time

    Job SummaryEnviri Corporation is seeking a highly skilled Claims Manager to oversee the management of workers' compensation and automobile liability claims. The ideal candidate will have a strong background in claims handling, excellent communication skills, and the ability to drive cost-effective resolutions.Key ResponsibilitiesDirect and manage complex...


  • Philadelphia, Pennsylvania, United States CHUBB Full time

    Chubb is seeking a Senior Claim Specialist for our Life Sciences Claims team. The Life Sciences Claims Team provides claim handling with regard to some of the largest medical products manufacturers and providers of instruments with worldwide distribution on the cutting edge of innovation, research and technology.This is an individual contributor role...


  • Philadelphia, Pennsylvania, United States Juno Search Partners Full time

    Job Title: Workers' Compensation Claims ManagerOur client, a leading environmental company, is seeking a skilled Claims Manager to oversee their workers' compensation and automobile liability claims. This role requires a strategic thinker who can analyze complex claims and develop effective solutions to minimize costs and ensure compliance.Key...


  • Philadelphia, Pennsylvania, United States IntePros Full time

    Claims Operations AnalystIntePros is seeking a skilled Claims Operations Analyst to join our team in Center City Philadelphia. As a key member of our operations team, you will be responsible for handling claims production tasks, supporting business operations, and identifying process improvements.Key Responsibilities:Claims Production: Handle written...


  • Philadelphia, Pennsylvania, United States Chubb Full time

    Reinsurance Claims Analyst RoleAs a key member of the Ceded Reinsurance Services team at Chubb, the Reinsurance Claims Analyst plays a vital role in ensuring the timely and accurate processing of reinsurance claims in North America.Key Responsibilities:Verify that claims are reported in accordance with reinsurance contract terms and ensure timely billings...


  • Philadelphia, Pennsylvania, United States Cozen O Connor Full time

    Recovery Analyst Job DescriptionCozen O'Connor is seeking a skilled Recovery Analyst to join our team. As a key member of our National Subrogation Services (NSS) team, you will play a crucial role in reviewing and resolving complex subrogation claims.Key Responsibilities:Review and analyze complex subrogation claims to determine viability and potential for...


  • Philadelphia, Pennsylvania, United States Chubb Full time

    Job DescriptionThis is a hybrid role following our 3/2 model (3 days in office and 2 days remote). The employee will be based out of our Philadelphia, PA office. Reporting to the Director, Ceded Reinsurance Services, this role is responsible for the day-to-day reinsurance claim operations in North America. The ceded reinsurance billings are primarily proof...


  • Philadelphia, Pennsylvania, United States Acadia Healthcare Full time

    At Acadia Healthcare, we are dedicated to providing exceptional patient care and are seeking an experienced Administrative Financial Support Specialist to join our team. This role will play a vital part in our insurance claims management process, ensuring that patients receive the financial assistance they need in a timely and accurate manner.As an...


  • Philadelphia, Pennsylvania, United States Ace American Insurance Full time

    Job Summary:As a Reinsurance Claims Analyst at Ace American Insurance, you will be responsible for the day-to-day reinsurance claim operations in North America. Your primary focus will be on ensuring timely billings and collections of loss balances, while providing accurate and complete billing packages to reinsurers and brokers. You will also be responsible...