Job Description

Claims Representative I, II, III

Location : The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.

The Claims Representative I 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.

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.

The Claims Representative II is responsible for keying, processing health claims in accordance with claims policies and procedures.

How you will make an impact :

• 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.

The Claims Representative III is responsible for keying, processing and / or adjusting health claims in accordance with claims policies and procedures.

How you will make an impact :

• 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.

Minimum Requirements :

• Claims Representative I - Requires HS diploma or equivalent and related experience; or any combination of education and experience which would provide an equivalent background.
• Claims Representative II - 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.

Claims Representative III - Requires a HS diploma and a minimum of 3 years of the companies internal claims experience;

or any combination of education and experience which would provide an equivalent background

Preferred Skills, Capabilities and Experiences :

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

Job Level :

Non-Management Non-Exempt

Workshift : Job Family :

Job Family : CLM >

CLM >

Claims Reps

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 for assistance.

Last updated : 2024-04-30