IntePros · 3 weeks ago
Claims Specialist
Philadelphia, PA
Contract
Hybrid
Entry, Mid Level
$25/hr - $28/hr
2+ years expIntePros is seeking an Inter-Plan Relations Coordinator responsible for resolving complex claims issues in collaboration with various stakeholders. The role involves ensuring compliance with servicing standards and facilitating issue resolution to enhance provider and member experiences.
ConsultingInformation TechnologyStaffing Agency
Hiring Manager
Celia Mazzarelli
Responsibilities
Resolve routine, complex, and escalated claims-related issues that impact providers and members by working with partner health plans, internal teams, and external stakeholders
Take full ownership of partner plan inquiries from intake through final resolution, coordinating cross-functional support as needed
Serve as a liaison between internal teams and partner health plans to ensure compliance with Inter-Plan Program (IPP) policies, processing standards, and servicing requirements
Track inquiry activity, conduct root-cause analysis, and prepare reports for leadership to support issue resolution at a national level
Identify, address, and eliminate operational issues and trends related to untimely, inaccurate, non-compliant, or inconsistent claims adjudication across multiple systems and inquiry platforms
Partner with Commercial and Government Operations teams to assess, recommend, and facilitate process improvement initiatives
Collect and analyze issue-related data and recommend educational materials for providers and members to reduce future inquiries
Manage open inventory (onsite and offsite) to meet stringent inter-plan servicing and turnaround time requirements
Receive, track, research, and resolve senior-level escalations in accordance with established escalation guidelines
Demonstrate leadership, accountability, and sound judgment in managing high-impact issues
Perform additional duties as assigned, including travel to partner plan sites when needed
Qualification
Required
High School Diploma or GED with 4 years of experience in a claims or service operations environment
OR
Bachelor's Degree with 2 years of experience in a claims or service operations environment
Demonstrated understanding of Inter-Plan policies, processing standards, and guidelines, including Home and Host responsibilities
Proven knowledge of Inter-Plan systems and workflows
Experience supporting multiple product lines, including: Medicare Advantage, Medicare Cross-Over, State Health Plans, Administrative Services Only (ASO), Fully Insured and Individual Products, National Accounts
Strong analytical, problem-solving, and decision-making abilities
Excellent written and verbal communication and presentation skills
Ability to collaborate effectively with internal teams and external partners at all levels
Strong organizational and time-management skills with the ability to meet strict service-level requirements
Demonstrated leadership and ownership of issues from initiation through resolution
Preferred
Experience designing, developing, and delivering customized, account-specific education programs within the healthcare industry
Company
IntePros
IntePros is an established, woman-owned, privately-held technology and business services consulting agency committed to building long-term relationships and helping more companies leverage the power of a more diverse workforce.
201-500 employees
H1B Sponsorship
IntePros has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (3)
2024 (3)
2023 (6)
2022 (7)
2021 (6)
2020 (13)
Funding
Current Stage
Growth StageLeadership Team
Loren Kovalcik
CEO
Company data provided by crunchbase