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Claims Representative I/II/III (Hlth & Dntl) - Indianapolis, IN - PS5952 in Indianapolis, IN at Anthem, Inc.

Date Posted: 5/17/2018

Job Snapshot

Job Description

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.
 
Claims Representative I-III (Health & Dental)

• Manager will determine level based upon the selected applicant’s skillset relative to the qualifications listed for this
position.*
 
Description
 
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:
Keys, processes and/or adjusts 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.
 
Level III:
Keys, processes and/or adjusts health claims in accordance with claims policies and procedures. Must be able to
successfully perform all the duties of the Claims Rep II.
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.
Qualifications
 
Level I:
- 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.).
 
Level II:
- HS diploma or GED;
- 1 to 3 years of 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.
- WGS experience preferred
 
Level III:
- HS diploma;
- 3 to 5 years of Anthem claims experience;
- or any combination of education and experience, which would provide an equivalent background.
- WGS experience required
 
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and
is a 2014 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.