Claims Representative II

Elevance Health • Durham, NC

21h • $17 - $29 • Hybrid

About The Position

Claims Representative II Location: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, 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. Hours: Monday through Friday 8 AM to 4:30 PM Eastern 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: Able to handle more complex claim 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. 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.

Requirements

• 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

Nice To Haves

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

Responsibilities

• keying
• processing health claims in accordance with claims policies and procedures
• handle more complex claim 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
• 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

Benefits

• 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).

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED