Supv Claims Operations

Responsibilities

• Provides operational oversight and governance of offshore vendor claims processing activities.
• Ensures vendor compliance with contractual service level agreements (SLAs), key performance indicators (KPIs), quality standards, and regulatory requirements.
• Maintains department standards to ensure an optimal customer and provider experience.
• Monitors daily, weekly, and monthly vendor performance metrics including productivity, accuracy, turnaround time, and quality results.
• Evaluates operational effectiveness and efficiency of vendor-managed workflows and partners with the vendor to reallocate resources or adjust processes as needed.
• Serves as the primary point of contact for operational issues, escalations, and resolution of vendor-related concerns.
• Collaborates with internal stakeholders (Claims Operations, Quality, Compliance, IT, Finance, and Vendor Management) to coordinate vendor activities and resolve issues.
• Communicates, interprets, and enforces corporate and departmental policies, procedures, and process changes with the offshore vendor.
• Supports implementation of new initiatives, system enhancements, and process changes involving the offshore vendor.
• Reviews and validates vendor training plans to ensure staff are properly trained on claims processing, systems, and Independence requirements.
• Provides ongoing feedback and coaching to vendor leadership to drive performance improvement and service excellence.
• Compiles, analyzes, and prepares operational reports related to vendor performance, trends, risks, and improvement opportunities.
• Encourages a culture of accountability, continuous improvement, and partnership with the offshore vendor.

Requirements

• Minimum of five (5) years of related insurance operations experience, with demonstrated experience in claims processing.
• Prior experience overseeing or working with offshore or third-party vendors strongly preferred.
• Demonstrated ability to handle sensitive operational, quality, and performance issues with tact, diplomacy, and professionalism.
• Strong vendor management and relationship management skills with the ability to influence without direct authority.
• Proven ability to analyze performance data, identify trends, and implement corrective actions.
• Excellent organizational, planning, and time management skills in a fast-paced, high-volume environment.
• Ability to prioritize work and adapt to frequently changing operational demands.
• Strong oral and written communication skills, including the ability to clearly convey expectations, feedback, and performance results to vendor partners.
• Ability to work independently with minimal guidance while maintaining accountability for outcomes.
• Experience in high-volume claims processing operations strongly preferred.
• Knowledge of Claims processing both local and BlueCard business, processes, and applications preferred.
• HealthRules experience preferred.

Qualifications

Minimum qualifications:

• High school diploma or equivalent.
• Valid driver's license and reliable transportation.

Skills

• Strong analytical and problem-solving skills.
• Excellent interpersonal and communication skills.
• Proficiency in Microsoft Office Suite.
• Ability to manage multiple tasks and priorities simultaneously.
• Strong attention to detail.

Benefits

Independence offers a comprehensive benefits package including:

• Health, dental, and vision insurance.
• 401(k) retirement plan with company match.
• Flexible spending accounts for healthcare and dependent care expenses.
• Life and disability insurance.
• Employee assistance program.
• Generous paid time off policy.

Pay

The salary range for this position is $75,000 - $90,000 annually, commensurate with experience.

Schedule

This position is typically Monday through Friday, 8:00 AM to 5:00 PM, with some evening and weekend work as needed.

About the Role

Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and well-being of the people and communities we serve.

Company Information

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

Independence Blue Cross 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.

Inclusion and Belonging

At IBX, everyone can feel valued, supported, and comfortable to be themselves, and all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. Celebrating and embracing diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

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.