Claims Examiner

Anticipated End Date:

Position Title:

Job Description:

Claims Examiner I

***UNION POSITION***

Location : This is a remote position however the associate will be mapped to the Rancho Cordova, CA office and may need to go into the office as requested by management for meetings or training opportunities.

This position will start at the U-15 rate for the first year.

Wage Range : $22.58 - $32.54/hr (Rancho Cordova, CA location)

This is an entry level position. During the time spent in this position the Claims Examiner will develop claims knowledge in all of the functions of the Claims Examiner l position. Additionally, the associate will develop knowledge on multiple accounts to become proficient in processing and may be assigned to claims, adjustments as required.

Responsibilities include:

• Reviews and evaluates claims for information on which to base payment.
• Manually calculates benefit determinations (non-payable, categories, savings and payments) and/or re-entering claims using PAC (Pre-Adjudication Correction) process for original and reopened claims to be adjusted.
• Refers to policy overage and benefit limitations information (i.e. medical guidelines, corporate policy, contract provisions, other coverage etc.) to determine the appropriate course of action (i.e. referral to MRU, claim reject, return to submittal etc.).
• Utilizes appropriate reference materials to research information, respond to, and resolve problems.
• Updating, manual processing, adjust claims and/or records as appropriate.
• Prepares reports and/or logs, as necessary.
• Maintains inquiry tracking appropriately.

Minimum Requirements :

• Minimum of one (1) year of Anthem Blue Cross medical claims processing experience (internal applicants shall have preference over external applicants) or medical claims processing/or other health insurance or equivalent education.

Preferred Skills, Capabilities & Experience :

• Familiarity with basic arithmetic computations and data entry.
• Knowledge of medical terminology and codes.
• Effective communication and personal computer skills.

 
Location: California (The associate will be mapped to the Rancho Cordova, CA office).
 
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, non-discriminatory 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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Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.