Independence Blue Cross · 1 month ago
Clinical Vendor Management Specialist - Hybrid (PA/NJ/DE)
Philadelphia, PA
Full-time
Hybrid
Senior Level
5+ years expIndependence Blue Cross is dedicated to enhancing the health and well-being of the communities it serves. The Clinical Vendor Management Specialist is responsible for developing financial strategies, analyzing reimbursement trends, and managing vendor relationships within the Clinical Vendor Management department.
Health CareHealth InsuranceInsuranceMedical
Responsibilities
Develop and maintain reimbursement and financial strategies for contracted vendors using knowledge of managed care finance and reimbursement methodologies
Analyze clinical, reimbursement, and savings trends; present findings to internal teams to identify opportunities and recommend improvements
Monitor, evaluate, and report on vendor performance through data analysis and performance metrics
Manage invoice payments and track administrative spend for vendors
Summarize complex analyses into clear, actionable insights to support vendor contract decisions
Collaborate with vendor specialists to document negotiated reimbursement terms into rate exhibits and payment notes
Identify and present cost avoidance and cost recovery opportunities independently or as part of a team
Provide technical assistance and interpretation of vendor payment processes to internal and external stakeholders
Reporting administrative spend, medical cost savings, and ROI by product, month, service, and segment (Fully Insured/Self-Funded)
Charge-back amounts and annual revenue for Self-Funded customers in vendor buy-up programs
Authorization patterns and trends from vendors
Membership data accuracy and trends across vendors
Shared-savings program payment tracking and reconciliation
Membership report reconciliation for accuracy
Serve as the primary relationship owner for assigned vendors, ensuring program performance and day-to-day support
Lead vendor contract negotiations and oversee tactical execution of third-party management functions
Ensure compliance with Vendor Management Policies and Procedures and applicable regulations
Act as an advisor to business areas and vendors on performance and contractual matters
May lead projects and train staff in areas of expertise
Perform other duties as assigned
Qualification
Required
Bachelor's degree in business, Finance, Health Care Management, Information Science, or a related field; Master's degree preferred
Minimum 5 years of progressive experience, preferably in managed care or provider environments
Strong analytical, technical, and problem-solving skills with experience manipulating and analyzing claims data
Familiarity with managed care and/or Medicare reimbursement terms, concepts, and methodologies
Excellent verbal and written communication skills; comfortable presenting to all levels of management
Ability to work independently and collaboratively in cross-functional teams
Strong organizational skills with the ability to manage multiple projects simultaneously
Detail-oriented with strong interpersonal skills
Advanced proficiency in Microsoft Access, Excel, PowerPoint, and Word
Preferred
Master's degree
Knowledge or familiarity of SQL, BigQuery, DART, Tableau Reporting, Catalyst, Front Office System (FOS) is a plus
Company
Independence Blue Cross
The leading health insurer in southeastern Pennsylvania. It is a sub-organization of Independence Blue Cross.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Alexandra Jorgensen
Senior Vice President Human Resources
Joe Geist
SVP & Market President, National
Recent News
Home Health Care News
2026-01-14
Company data provided by crunchbase