Independence Blue Cross

Lead EDI Specialist

Independence Blue Cross$75K — $95K *
Healthcare
Less than 5 years of experience
Job Overview by Ladders

Qualifications

  • 5-7 years of experience in enrollment operations or equivalent role.
  • Strong understanding of EDI processes and systems.
  • Proficient in Microsoft Applications.
  • Detail-oriented with exceptional organizational skills.
  • Proven ability to drive process improvements.

Responsibilities

  • Lead reconciliation efforts for enrollment operations systems.
  • Review complex inbound 834 files and develop best practices.
  • Identify opportunities for process improvements in enrollment operations.
  • Act as a liaison for cross-departmental enrollment initiatives.
  • Manage the flow of inbound EDI files for clients.
  • Develop and document procedures for enrollment processes.
  • Oversee robotic process automation activities within the business area.

Benefits

  • Opportunity to work in a fast-paced environment
  • Comprehensive training and development support
  • Exposure to cross-functional teams and projects
  • Engagement in process improvement initiatives
  • Support for mobile application use to enhance work efficiency
Full Job Description
• Lead reconciliation efforts for Core Self-Funded Enrollment Operations to ensure that key systems are updated.
• Review complex inbound 834 and alt 834 file issues in pre-edit/post-release to develop best practices for analysis, reconciliation, and resolution.
• Responsible for identifying process improvement opportunities that can enhance quality and efficiency without sacrificing service.
• Liaison between Core Self-Funded Enrollment Operations and BTS/Compliance/Marketing/Client Implementation for enrollment impacting initiatives.
• Act as subject matter expert for group requests and coordinate technical/process changes.
• Document/prioritize system limitations and coordinate with HealthEdge/BTS to identify technical solutions or automation opportunities.
• Successfully manage the flow of inbound EDI files for Core SF client business.
• Develop and document procedures/job aides/service alerts/policies for enrollment processes.
• Manage initial enrollment file loads for new client installations.
• Assist and train team members as needed.
• Manage team inventory activity.
• Lead enrollment related issues resolution for Enrollment Resolver Group.
• Organize/disperse team project work to other team members.
• Work on ad-hoc projects as requested.
• Responsible for managing all robotic process automation (RPA) work for the business area.
• Other duties as assigned by the Leadership Team.
• Ability to work and coordinate enrollment process and Analytics for Core Self-Funded Enrollment Operations.
• Represent Core Self-Funded Enrollment Operations during customer integration projects, operational meetings between IBC divisions, new implementations, integration and new product development, key control audits, regulatory examinations, interaction with Health Edge (or other vendors).
• Acute knowledge of EDI & enrollment systems. Understanding of XML/ANSI 834/HIPAA X12transactions is beneficial but not required.
• Must possess the ability to interface with internal/external customers at various levels.
• Demonstrate experience in training & development.
• Willingness to work in a fast-paced, challenging environment.
• Detail oriented and organized, with exceptional prioritization skills.
• Ability to effectively communicate with senior management, supervisors, peers, and clients.
• Proficient in Microsoft Applications.
• Proven process improvement methodology and driving change management.
• Requires an extensive knowledge of EDI Portal functionality and managing inbound EDI enrollment file activity.
• Experience in the Health Rules system platform, understanding of the Front Office System and how these platforms interact with EDI Portal for EDI enrollment validation.

Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.

About Independence Blue Cross

Independence Blue Cross (IBC) is a health insurance company based in Philadelphia, Pennsylvania. It is one of the largest health insurers in the United States, serving over 8 million people in 24 states and the District of Columbia. IBC offers a variety of health insurance plans, including individual and family plans, Medicare plans, and employer-sponsored plans. The company also provides wellness programs and other health-related services to its members. IBC was founded in 1938 as the Associated Hospital Service of Philadelphia and changed its name to Independence Blue Cross in 1988.
Learn more about Independence Blue Cross
Size
8,500 employees
Industry
Founded
1938

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