Issue Resolution Specialist

Key Responsibilities

• Manage and prioritize a daily caseload to ensure cases are resolved accurately, efficiently, and within required compliance timeframes
• Investigate and analyze case details, identify root causes, and determine effective resolutions
• Collaborate with cross-functional teams to drive timely and accurate case outcomes
• Draft clear, professional, and comprehensive written responses addressing consumer concerns
• Interpret and apply ACA, CMS, and State-Based Exchange regulations in all casework
• Identify trends and recommend process improvements to enhance operational performance
• Provide regular status updates on open cases and assigned work
• Support team training and knowledge sharing
• Ensure a positive member experience through accurate, timely, and compliant resolutions
• Perform additional duties as assigned

Qualifications

• Bachelor’s degree preferred
• 2–3 years of experience in the healthcare industry

Skills & Experience

• Working knowledge of healthcare operations such as billing, claims, enrollment, benefits, accounts receivable/payable
• Strong analytical, investigative, and problem-solving skills
• Excellent written and verbal communication skills, with the ability to clearly explain complex information
• Ability to interpret regulations and apply them in real-world scenarios
• Highly organized, detail-oriented, and able to manage multiple priorities
• Sound judgment and decision-making skills
• Ability to thrive in a fast-paced, evolving environment
• Proficiency in Microsoft Office (Excel, Access, Word, PowerPoint, Outlook)
• Familiarity with ACA, CMS, and State-Based Exchange regulations is a plus

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.

Equal Employment Opportunity

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.