Claims Rep I (Health & Dental) (US)

Anticipated End Date:

Position Title:

Job Description:

Title: Claims Representative I (Health & Dental)

The Claims Representative I will be 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.

• 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.)

Minimum Requirements

• HS diploma or equivalent and related experience; or any combination of education and experience which would provide an equivalent background.

Preferred Qualifications

• Good oral and written communication skills, previous experience using PC, database system, and related software (word processing, spreadsheets, etc.) strongly preferred.

• Ability to work from home with hard-wired internet access and a quiet and private workspace strongly preferred.

• Familiarity with basic arithmetic computations and data entry preferred.

• Knowledge of medical terminology and codes preferred.

• Effective communication and personal computer skills preferred.

Job Level:

Workshift:

Job Family:

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.