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Claims Rep I or II | Cerritos, CA | Job ID: PS10748 in Cerritos, CA at Anthem, Inc.

Date Posted: 1/3/2019

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Cerritos, CA
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    1/3/2019

Job Description

Your Talent. Our Vision.  At CareMore, a proud member of the Anthem, Inc. family of companies specializing in providing senior Americans a complete and pro-active health care experience, it’s a powerful combination.  It’s 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.  

Responsible for keying, processing and/or adjusting health claims in accordance with claims policies and procedures. Works without significant guidance w/ basic understanding of multiple products (HMO, PPO, COB, etc.). Must be able to successfully perform all the duties of the Claims Rep I. 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. 

  • Requires a HS diploma or equivalent
  • 1+ 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.
AnEqualOpportunityEmployer/Disability/Veteran