Issue Resolution Specialist

Issue Resolution Specialist

Independence is a Qualified Health Plan issuer participating in the Federally Facilitated Marketplace and State-Based Exchanges (SBE). We are responsible for resolving Exchange casework within strict regulatory timeframes that directly impact members' access to healthcare. As an Issue Resolution Specialist, you will play a critical frontline role in investigating and resolving complex cases. This is an opportunity to apply your analytical skills, problem-solving abilities, and attention to detail to make a meaningful impact on member experiences while navigating a dynamic and highly regulated environment.

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

Bachelor's degree preferred 23 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

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.

Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.