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Claims Rep I,II, III Health (Remote) (PS32997)Location: United StatesNewRequisition #: PS32997Your Talent. Our Vision . At Anthem, Inc ., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.Claims Rep (Health) Level I, II, or IIIPlease note: This position will be filled at either the I, II, or III level. The hiring manager will determine the appropriate level based upon the selected applicant's experience and skill set relative to the qualifications listed for this position.LEVEL IThis role 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.Primary duties may include, but are not limited to:
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.
LEVEL IIThis role is responsible for keying, processing and/or adjusting health claims in accordance with claims policies and procedures. Works without significant guidance w/ basic understanding of multiple products (HMO, PPO, COB, etc.). Must be able to successfully perform all the duties of the Claims Rep I.Primary duties may include, but are not limited to:
Able to handle more complex claims.
Good understanding of the application of benefit contracts, pricing, processing, policies, procedures, gov't regs, coordination of benefits, & healthcare terminology.
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.
LEVEL IIIThis role is responsible for keying, processing and/or adjusting health claims in accordance with claims policies and procedures. Must be able to successfully perform all the duties of the Claims Rep II.Primary duties may include, but are not limited to:
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.
LEVEL I
Requires HS diploma or equivalent
Up to 1 year of related experience
Or any combination of education and experience, which would provide an equivalent background.
Good oral and written communication skills
Previous experience using PC, database system, and related software (word processing, spreadsheets, etc.).
LEVEL II
Requires a HS diploma or equivalent
1-3 years 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.
LEVEL III
Requires a HS diploma
3-5 years of the companies internal claims experience
Or any combination of education and experience, which would provide an equivalent background.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.
Vacancy expired!