Claims Representative II

Anticipated End Date:

Position Title:

Claims Representative II

Job Description:

Claims Representative II

Location:

This role enables associates to work virtually full-time, except for 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.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Hours:

Monday through Friday 8 AM to 4:30 PM Eastern

The Claims Representative II is responsible for keying, processing health claims in accordance with claims policies and procedures. Works without significant guidance w/ basic understanding of multiple products (HMO, PPO, COB, etc.).

How you will make an impact:

* Able to handle more complex claim with a good understanding of the application of benefit contracts, pricing, processing, policies, procedures, government regs, coordination of benefits, healthcare terminology and/or adjust claims.

* 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.

Minimum Qualifications:

* Requires a HS diploma or equivalent and a minimum of 1 year 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.

Preferred Skills, Capabilities and Experiences:

* System knowledge in some or all of the following is strongly preferred:
Edifec, CAS, Service Connect, Flex Care, Vault

For candidates working in person or virtually in the below locations, the salary
* range for this specific position is $16.88 to $28.94

Location(s):
New York

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations.

No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

Job Level:

Non-Management Non-Exempt

Workshift:

Job Family:

CLM  Claims Reps

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a…