Claims Representative I, II

4 weeks ago

Independence, United States Elevance Health Full time

Claims Representative I, II

Location : This is a remote position. Ideal candidates will live within 50 miles of an Elevance Health PulsePoint office location in the Eastern time zone .

Work Schedule : Monday - Friday 8:00am - 4:30pm EST

The Claims Representative I is responsible for successfully completing the required basic training. Able to perform basic job functions with help from co-workers, specialists and managers on non-basic issues.

The Claims Representative II is responsible for keying, processing health claims in accordance with claims policies and procedures. Works without significant guidance w/ basic understanding of multiple products (HMO, PPO, COB, etc.).

How you will make an impact:

Claims Representative I

  • Learning the activities/tasks associated with his/her role.

  • Works under direct supervision.

  • Relies on others for instruction, guidance, and direction.

  • Work is reviewed for technical accuracy and soundness.

  • Codes and processes claims forms for payment ensuring all information is supplied before eligible payments are made.

  • Researches and analyzes claims issues.

Claims Representative II

  • Able to handle more complex claim with a good understanding of the application of benefit contracts, pricing, processing, policies, procedures, government regulations, coordination of benefits, healthcare terminology and/or adjust claims.

  • Good working knowledge of claims and products, including the grievance and/or re-consideration process.

  • Excellent knowledge of the various operations of the organization, products, and services.

  • Reviews, analyzes and processes claims/policies related to events to determine extent of company's liability and entitlement.

  • Researches and analyzes claims issues.

  • Responds to inquiries, may involve customer/client contact.

Minimum Requirements:

  • Claims Representative I requires HS diploma or equivalent and related experience; or any combination of education and experience which would provide an equivalent background.

  • Claims Representative II requires a HS diploma or equivalent and a minimum of 1 year of claims processing experience; previous experience using PC, database system, and related software (word processing, spreadsheets, etc.); or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

  • Good oral and written communication skills, previous experience using PC, database system, and related software (word processing, spreadsheets, etc.) strongly preferred.

  • Healthcare and/or health insurance experience preferred.

  • Call center experience preferred.

  • Experience working in a fast-pace, high volume environment preferred.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $15.31 to $28.12/hr.

Location: New York

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, nondiscriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

  • The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

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