Inter-Plan Relationship Coordinator

Operations

Resolves common, complex and escalated issues directly impacting IBX Out-of-Area (HOST) provider claims by working with other BCBS Health Care Plans or directly with internal business teams.

Tracks issues, provides root cause analysis and escalates to Management enabling issues to be addressed at a National level.

Partners with all areas of company, especially the various IBX provider teams to achieve timely issue resolution and compliance with other BCBS Health Care Plans' benefits requirements.

Takes ownership of resolving a partner plan inquiry from start to completion, including when an issue requires assistance of another internal area.

Acts as a liaison between IBX and all partner BCBS Health Care Plans to ensure end to end resolution of issues for all claims in accordance with the Inter-Plan Program (IPP) requirements.

Identifies and aids in establishing business requirements for system updates / changes to eliminate "operational" issues that are identified as trends / patterns of untimely, inaccurate, non-compliant or inconsistent claims adjudication for our participating providers or partner BCBS Health Care Plans involving multiple system and inquiry platforms.

Collects information related to issues and provides recommendations for educational material for the IBX provider community, especially where it concerns Host claims policies and processing.

Able to effectively use Internal reporting tools to manage, analyze, and perform trend analysis of open and closed inventory both onsite and offsite to meet stringent BCBS Association requirements.

Receives tracks and research Director level and above escalations for timely resolution in accordance with BCBSA escalation guidelines.

Demonstrated leadership, information driven decision-making, problem solving, organization and planning skills are essential to be successful in this position.

Effective presentation and communication skills, both oral and written are essential.

Ability to interact effectively with Providers / Partner Plan Staff at all levels and IBX associates at all levels, and across all departments.

Must be able to work efficiently in a team environment as well as individually.

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.