Claims Representative I/II/III (Health & Dental) - Midland, GA - 136694
Location:
Columbus , Georgia
Posted:
November 21, 2017
Reference:
1712041697
_Claims Representative I/II/III (Health & Dental) - Midland, GA - 136694_
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Your Talent. Our Vision. At Anthem, Inc., it's a powerful combination, and the foundation upon which we're creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.

Our Claims Representative position is an opportunity for you to use your problem solving and research skills to process claims for our consumers (members and providers) in order for them to have a good consumer experience with Anthem.

The Claims Representative has multiple levels; therefore, you can progress your career based on your skills, etc. This role will enable you to set a career path in the healthcare industry and play a vital role in helping Anthem consumers feel connected and educated about their claims benefits.

We are seeking talented, accountable, and enthusiastic individuals to analyze and process claims accurately and timely. A background in the healthcare industry is not required, but you must be a self-motivator and share our commitment to an easy- to-do-business with model. We are looking for people who have a passion with the following qualities:
Treating every claim as if it was your own
Taking accountability
Helping to resolve problems; desire to "dig deeper"
Ability to connect the dots for our consumers (members/providers)
Ownership of an issue that may not belong to you
Primary duties may include, but not limited to:

Level I:
Successfully completed 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.

Primary duties may include, but are not limited to:
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.
Level II:
Primary duties may include, but are not limited to:
Able to handle more complex claims.
Good understanding of the application of benefit contracts, pricing, processing, policies, procedures, gov't regs, coordination of benefits, & healthcare terminology.
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.
Level III:
Primary duties may include, but are not limited to:
Fully proficient in all key areas; performs many complex functions.
May 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.

HS diploma or equivalent.
Up to 1 year of 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.).
Ability to work independently as necessary, take ownership and pay attention to detail
Analytical and researching skills is preferred.
Strong Interpersonal communication skills is preferred.
WGS, FACETS, and NETWORX PRICER is preferred.
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.

Job Claims

Equal Employment Opportunity Statement
Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.

Title: Claims Representative I/II/III (Health & Dental) - Midland, GA - 136694

Location: GA-Midland

Requisition ID: 136694

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