Claims Representative II (Health & Dental)

Elevance Health•Atlanta, NY

5d•Remote

About The Position

The Claims Representative II is responsible for keying and processing health claims in accordance with claims policies and procedures. This role involves working without significant guidance and requires a basic understanding of multiple products such as HMO, PPO, and COB. The position involves handling more complex claims with a good understanding of benefit contracts, pricing, processing, policies, procedures, government regulations, coordination of benefits, and healthcare terminology. It also includes researching and analyzing claims issues, and responding to inquiries, which may involve customer/client contact.

Requirements

High school diploma or equivalent.
A minimum of 1 year of claims processing experience.
Previous experience using PC, database system, and related software (word processing, spreadsheets, etc.).
Candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Nice To Haves

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.
System knowledge in some or all of the following is strongly preferred: Edifec, CAS, Service Connect, FlexCare, Vault.

Responsibilities

Keying and processing health claims in accordance with claims policies and procedures.
Handling more complex claims with a good understanding of the application of benefit contracts, pricing, processing, policies, procedures, government regs, coordination of benefits, healthcare terminology and/or adjust claims.
Reviewing, analyzing and processing claims/policies related to events to determine extent of company's liability and entitlement.
Researching and analyzing claims issues.
Responding to inquiries, which may involve customer/client contact.