Claims Processor; Dearborn, MI

Job Code: Salary Grade:
Union – Grade 4

Exemption Status: Non-Exempt

Reports to: Manager, Claims Processors

Virtual: This role enables associates to work virtually full-time, with the exception of required in‑person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work‑life integration, and ensures essential face‑to‑face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Shift hours:

• 8am EST - 4:30pm EST Monday - Friday.

• Verify the accuracy of claims data entered by a data entry clerk and accurately complete the data entry of additional claims data necessary to adjudicate the claim.
• Research claims for additional or missing information.
• Utilize pre‑established screening guidelines and templates to review claims information to determine member eligibility, level of benefits and if claims should be paid.
• Route claims information to appropriate departments for action, if necessary.
• Review open claims’ reports on a daily basis to ensure that claims are processed quickly and accurately while meeting Departmental accuracy, productivity and performance standards.
• Process mailbacks and submit for audit.
• Complete daily production logs and turn them in daily to the Claims Department Manager by the end of shift or before leaving for the day.
• Ensure that any data required for reporting purposes is entered as instructed by auditor or directed by management.
• Promptly raise any issues delaying resolution of the claim to management.
• Contribute to overall success of the claims department in meeting performance guarantees to customers and maintaining customer standards.

• High school diploma or a GED equivalent.
• 1 year of claims processing or medical billing experience required.

• Claims processing experience preferred.
• Claims/Billing certification from an accredited business institution preferred.
• Knowledge and experience using management information systems and software CAS or other computerized claims processing system preferred.
• Word processing and excel experience preferred.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.

Applicants who require accommodation to participate in the job application process may contact elevancehealthj for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.