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Appeals & Grievances at Independence Blue Cross LLC

Posted in Legal Admin 30+ days ago.

This job brought to you by eQuest

Type: Full-Time
Location: Philadelphia, Pennsylvania

Job Description:

With the ever-changing healthcare industry, Independence is constantly sourcing top talent for the organization. Individuals with Appeals and Grievances experience are crucial to our operational success. Candidates with this type of skillset are welcome to apply as we continue to advance with the healthcare industry.

Appeals and Grievances Skillsets:

  • Minimum 3 years’ experience in a Medicare setting handling customer complaints with prior experience in:

    • Preparing case files for both clinical and administrative review

    • Ensuring case file documents are filed and secured per unit guidelines and are submitted timely for Q/A purposes

    • Thoroughly researching and investigating the history relevant to the case, including the member’s enrollment and eligibility status, benefit plan and circumstances surrounding denial of services or rejection of claims

  • Working knowledge of Medicare and Medicare Supplemental products is also preferred

  • Excellent interpersonal skills to interact with internal and external customers

  • Demonstrate their ability to handle complex member issues

  • Exceptional writing, editing and proofreading skills

  • Working knowledge of Word and Excel is a plus

If you thrive in a collaborative culture and have a passion for solving some of health care’s biggest challenges, Independence Blue Cross may be the place for you. Serving more than 8.5 million people in 24 states and Washington, D.C., including more than 2.5 million in the region, Independence Health Group is the leading health insurance company in the Philadelphia region, and we’re expanding across the country. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.
At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations.