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Anthem, Inc. Claims Representative I, II (Hlth & Dntl) in Pewaukee, Wisconsin

Description

SHIFT: Day Job

SCHEDULE: Full-time

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 care companies and a Fortune Top 50 Company.

Claims Representative I Responsibilities:

  • Responsible for successfully completing 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.

Claims Representative II Responsibilities:

  • 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.).

Primary duties may include, but are not limited to:

  • 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.

  • 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.

Qualifications

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against Covid-19. All offers of employment are conditioned on completion of a background check, including COVID-19 vaccination verification. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

Claims Representative I Minimum Requirements:

  • Requires HS diploma or equivalent and related experience; or any combination of education and experience which would provide an equivalent background.

Claims Representive I Preferred Qualifications:

  • Good oral and written communication skills

  • Previous experience using PC, database system, and related software (word processing, spreadsheets, etc.)

Claims Representative II Minimum Requirements:

  • Requires a HS diploma or equivalent

  • Minimum of 1 year of claims processing experience; or any combination of education and experience which would provide an equivalent background.

Claims Representative II Preferred Qualifications:

  • 1-3 years of Claims Processing experience

  • 1+ years of Medicare experience

  • Previous healthcare expeirence

  • Good oral and written communication skills

  • Previous experience using PC, database system, and related software (word processing, spreadsheets, etc.)

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

REQNUMBER: PS63710-Wisconsin

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