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Claims Examiner II - AHG- UNION - Rancho Cordova, CA - PS12724 in Rancho Cordova, CA at Anthem, Inc.

Date Posted: 9/14/2018

Job Snapshot

Job Description

Claims Examiner II - Union - Rancho Cordova, CA - PS12724

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.
 
Responsibilities include:
  • Reviewing and evaluating claims for information on which to base payment
  • Manually calculating benefits determination (non-payable categories, savings and payments) and/or re-entering claims using the PAC (Pre-Adjudication Correction) process for original and re-opened claims to be adjusted
  • Referring to policy coverage and benefits limit 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.)
  • Utilizing appropriate reference materials to research information, respond to, and resolve problems
  • Preparing and/or initiating a variety of correspondence and documents to respond to inquiries/problems
  • Updating, manually processing, adjusting claims and/or records as appropriate
  • Preparing reports and/or logs, as necessary
  • Maintaining inquiry tracking appropriately


  • Minimum two years Anthem Claims Examiner I or claims processing/health insurance or equivalent education.
  • Familiarity with basic arithmetic computations and data entry.
  • Thorough knowledge of medical terminology and codes.
  • Demonstrated effective communication and personal computer skills. 
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. AnEqualOpportunityEmployer/Disability/Veteran