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Claims Representative III (Health & Dental)

  • Job
    Full-time
    Mid Level
  • Customer Relations
    Healthcare
  • Tampa

AI generated summary

  • You must be within 50 miles of specified locations, have a high school diploma, 3 years of claims experience, and preferably skills in data analytics and research. COVID-19 vaccination required.
  • You will handle claims inquiries, adjust claims as needed, assist with staff training, and participate in workflow projects with minimal supervision.

Requirements

  • Must be located within 50 miles of Norfolk, VA, Tampa, FL, Des Moines, IA or Mason, OH.
  • Requires a high school 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.
  • Experience with data analytics preferred.
  • Ability to research preferred.
  • Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
  • We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19.

Responsibilities

  • 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.

FAQs

What are the primary responsibilities of a Claims Representative III (Health & Dental)?

The primary responsibilities include keying, processing, and/or adjusting health claims, responding to inquiries regarding benefits and claims, adjusting voids and reopens claims online, and potentially assisting with staff training.

What is the minimum education requirement for this position?

The minimum education requirement is a high school diploma, along with a minimum of 3 years of internal claims experience or an equivalent combination of education and experience.

Are there any preferred qualifications for this role?

Yes, preferred qualifications include experience with data analytics and the ability to conduct research.

Is this position location-specific?

Yes, candidates must be located within 50 miles of Norfolk, VA, Tampa, FL, Des Moines, IA, or Mason, OH.

Does Elevance Health require COVID-19 vaccination for this role?

Yes, Elevance Health requires all new candidates in certain patient/member-facing roles to be vaccinated against COVID-19, unless an acceptable explanation is provided for not being vaccinated.

Are there opportunities for professional growth within Elevance Health?

Yes, Elevance Health emphasizes creating a culture that fosters personal and professional growth for associates.

What benefits does Elevance Health offer to its employees?

Elevance Health offers a range of market-competitive total rewards, including medical, dental, and vision benefits, 401(k) with a match, stock purchase plans, paid time off, incentive bonus programs, and wellness programs.

Will I have contact with customers or clients in this role?

Yes, the Claims Representative III may have customer/client contact.

Is training provided for new staff in this role?

Yes, the Claims Representative III may assist with the training of new staff.

What is the work environment like?

The role operates in a hybrid workforce strategy, requiring associates to work at an Elevance Health location at least once a week, with specific requirements discussed during the hiring process.

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.