Claims Repricer

Position Summary

The Claims Repricer is responsible for the accurate review, adjustment, and application of pricing methodologies to medical claims. This role ensures claims are priced in accordance with provider contracts, fee schedules, and benefit structures. The position plays a critical role in maintaining pricing integrity, minimizing rework, and supporting operational efficiency in a high-volume claims environment.

Key Responsibilities

• Review and reprice medical claims to ensure accurate application of provider contracts, fee schedules, and reimbursement methodologies
• Analyze pricing discrepancies and perform adjustments to align with contractual and system guidelines
• Research complex claims scenarios, including escalations from Provider Services and Claims Processing
• Partner with Configuration, Network Management, and Claims teams to resolve pricing issues and system defects
• Maintain productivity, quality, and turnaround time standards in a high-volume environment
• Document findings and maintain audit-ready records of adjustments and issue resolution
• Identify pricing trends, root causes, and recommend process improvements to reduce errors and rework

Required Qualifications

• A high school diploma or equivalent required; Associate’s or Bachelor’s degree preferred
• 2–4 years of experience in healthcare claims processing, pricing, or repricing
• Strong knowledge of claims adjudication and reimbursement methodologies (e.g., fee schedules, contract pricing)
• Experience interpreting provider contracts and pricing logic preferred
• Strong analytical and problem-solving skills with attention to detail
• Ability to manage fluctuating workloads and prioritize effectively
• Proficiency in Microsoft Office (Excel, Word) and claims systems

About Our Company

Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region.

Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.

We are revolutionizing health care, and our focus is on you!

Independence Health Group 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.