Top 2 Spec problem resolution Jobs in Philadelphia, Pa

Provider Claims Svcs Spec
Independence Blue Cross —Philadelphia, PA
- Microsoft Excel
- Microsoft Outlook
- Research
Seating Specialist
Global Industries —Evesham, NJ
- $27.18 - $38.05 an hour
- Full-time
- Mid-level
- High school diploma or GED
- Product management
- Health savings account
- AD&D insurance
Quick Apply

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Provider Claims Svcs Spec

Independence Blue Cross -
Philadelphia, PA

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Job Details

Qualifications

Microsoft Excel
Microsoft Outlook
Research
High school diploma or GED
MFA
Healthcare software applications

Full Job Description

Job Profile Summary

The Provider Claims Service Specialist is responsible for responding to provider inquiries and resolving issues related to claims processing, reimbursement, and pricing. This role acts as a liaison between providers and internal claims operations teams to ensure accurate, timely resolution and a high level of service in a fast-paced environment.

Key Responsibilities

Research and resolve provider inquiries related to claim status, pricing, reimbursement, and contract interpretation
Analyze claim processing issues to identify root causes and implement corrective actions
Collaborate with internal departments (e.g., Claims, Configuration, Network Management) to address escalated issues
Review and interpret provider contracts to ensure accurate claims adjudication
Monitor and manage assigned work queues to meet productivity and quality standards
Maintain detailed documentation of issue resolution and provider interactions
Identify trends and recommend process improvements to enhance operational efficiency and provider experience
Support provider education by explaining claim outcomes, policies, and procedures

Required Qualifications

High school diploma or equivalent required; Associate’s or Bachelor’s degree preferred
2–4 years of healthcare claims processing or provider services experience
Strong knowledge of medical claims adjudication and reimbursement methodologies
Familiarity with provider contracts and pricing logic preferred
Excellent analytical, problem-solving, and communication skills
Ability to manage high-volume workloads and prioritize effectively
Proficiency in Microsoft Office (Excel, Word, Outlook) and claims processing systems

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.

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spec problem resolution jobs in philadelphia, pa

Provider Claims Svcs Spec

Seating Specialist

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