Claims Representative I, II, III

1 month ago


Tampa, United States Elevance Health Full time

Claims Representative I, II, III Location: The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. 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. Must pass the appropriate pre-employment test battery. How you will make an impact: 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. 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: 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. The Claims Representative III is responsible for keying, processing and/or adjusting health claims in accordance with claims policies and procedures. How you will make an impact: Participate in claims workflow projects. Responds to telephone and written inquiries and initiates steps to assist callers regarding issues relating to the content or interpretation of benefits, policies and procedures, provider contracts, and adjudication of claims. Adjusts voids and reopens claims on-line within guidelines to ensure proper adjudication. May have customer/client contact. May assist with training of staff. Works without significant guidance. 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. Claims Representative III - Requires a HS diploma and a minimum of 3 years of the companies internal claims experience; 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.



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