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Claims Rep I (Health & Dental) (US)

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Elevance Health

13d ago

  • Job
    Full-time
    Entry Level
  • Customer Relations
    Healthcare
  • Columbus, +2
  • 16d left

AI generated summary

  • You need a HS diploma or equivalent, good communication skills, PC proficiency, and familiarity with arithmetic and medical terminology. A quiet workspace and internet access are preferred.
  • You will learn claims processing under supervision, code claims, analyze issues, calculate benefits, and refer to policies for appropriate actions.

Requirements

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

Responsibilities

  • 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.)

FAQs

What is the job title for this position?

The job title is Claims Representative I (Health & Dental).

Where is this position located?

This position is hybrid, requiring attendance at the Elevance Health PulsePoint location at 6087 Technology Pkwy, Columbus, GA 31820, for on-site training and three days of work in the office after training.

What are the working hours for this position?

The working hours are from 9:00 am to 5:30 pm EST, Monday through Friday.

Is there a required attendance policy during training?

Yes, 100% attendance during the first 6 weeks of training is mandatory.

When is the expected start date for this position?

The expected start date is January 6, 2025.

What are the responsibilities of the Claims Representative I?

Responsibilities include completing required training, coding and processing claims, researching claims issues, manually calculating benefit determinations, and referring to policy information for appropriate action.

What are the minimum qualifications for this position?

The minimum qualifications are a high school diploma or equivalent and related experience or any combination of education and experience providing an equivalent background.

What preferred qualifications are sought for this role?

Preferred qualifications include good oral and written communication skills, experience with PCs and databases, familiarity with basic arithmetic computations, knowledge of medical terminology and codes, and effective communication skills.

Is it necessary to have hard-wired internet access for this role?

Yes, having hard-wired internet access and a quiet, private workspace is strongly preferred for remote work.

Does Elevance Health offer any benefits to employees?

Yes, Elevance Health offers a range of market-competitive total rewards including merit increases, paid holidays, Paid Time Off, medical, dental, vision benefits, wellness programs, and 401(k) matching, among others.

Is COVID-19 vaccination required for new candidates in certain roles?

Yes, new candidates in certain patient/member-facing roles are required to be vaccinated against COVID-19, or they must provide an acceptable explanation if they are not vaccinated.

What is Elevance Health's policy on equal employment opportunity?

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to various protected statuses.

How can applicants request accommodations during the application process?

Applicants requiring accommodation may contact elevancehealthjobssupport@elevancehealth.com for assistance.

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Elevance Health

Improving the health of humanity

Science & Healthcare
Industry
10,001+
Employees

Mission & Purpose

Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner.   Our nearly 100,000 associates serve more than 118 million people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health.  We believe that improving health for everyone is possible. It begins by redefining health, reimagining the health system, and strengthening our communities.