Job Description

Claims Representative I, II

Location : This is a remote position. Ideal candidates will live within 50 miles of an Elevance Health PulsePoint office location in the Eastern time zone .

Work Schedule : Monday - Friday 8 : 00am - 4 : 30pm EST

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.

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 :

Claims Representative I

• 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.

Claims Representative II

• Able to handle more complex claim with a good understanding of the application of benefit contracts, pricing, processing, policies, procedures, government regulations, 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.

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.

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.
• Healthcare and / or health insurance experience preferred.
• Call center experience preferred.
• Experience working in a fast-pace, high volume environment preferred.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $15.31 to $28.12 / hr.

Location : New York

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, nondiscriminatory 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.

Job Level :

Non-Management Non-Exempt

Workshift :

1st Shift (United States of America)

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.

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 : 2024-06-03