THIS POSITION MUST BE LOCATED IN FOND du LAC, WI
Anthem Blue Cross and Blue Shield is a proud member of the WellPoint family of companies. At Anthem, we are dedicated to our mission of improving the health of the people we serve. We believe the best health care coverage can actually help people stay healthy.
Bring your expertise to our innovative, performance-focused culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.
The Claims Rep I, II, or III
This position must be able to work in a fast-paced production environment.
Responsibilities include, but are not limited to, reviewing claims information for accurate claims adjudication, determining the specific level of coverage and utilizing multiple systems to access and record claim information needed to make accurate payment decisions.
The Claims Rep I will:
Be provided training and will be learning the activities/tasks associated with his/her role.
Work under direct supervision.
Rely on others for instruction, guidance, and direction.
Work is reviewed for technical accuracy and soundness.
Code and process claims forms for payment ensuring all information is supplied before eligible payments are made.
Researches and analyzes claims issues.
Have limited decision making with guidance from more senior processors.
The Claims Rep II will:
Keys, processes and/or adjusts health claims in accordance with claims policies and procedures.
Work without significant guidance w/ basic understanding of multiple products (HMO, PPO, COB, etc.).
Able to handles more complex claims.
Good understanding of the application of benefit contracts, pricing, processing, policies, procedures, govt regs, coordination of benefits, & healthcare terminology.
Good working knowledge of claims and products, including the grievance and/or re-consideration process.
Have excellent knowledge of the various operations of the organization, products, and services.
Review, analyze and process claims/policies related to events to determine extent of companys liability and entitlement.
Researches and analyzes claims issues.
Respond to inquiries, may involve customer/client contact.
Good oral and written communication skills.
Have previous experience using PC, database system, and related software (word processing, spreadsheets, etc.).
Claims Rep III will:
Key, process and/or adjust health claims in accordance with claims policies and procedures.
Fully proficient in all key areas; performs many complex functions.
May participate in claims workflow projects.
Respond 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.
Adjust, void and reopen claims on-line within guidelines to ensure proper adjudication.
Have customer/client contact.
Work without significant guidance.
Assist with training of staff.