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Claims Representative II/III ...

Monster
 
 
 
 

Job Summary

Company
Anthem
Location
Miami, FL
Industries
Other/Not Classified
Job Type
Full Time
Employee
Career Level
Experienced (Non-Manager)
Job Reference Code
4298_PS4722

Claims Representative II/III - Miami, FL - PS4722

About the Job

Description
Claims Representative II/III - Miami, FL

Your Talent. Our Vision. At Simply Healthcare, a proud member of the Anthem, Inc. family of companies, it's a powerful combination and the foundation upon which we're creating greater care for our members, greater value for our customers, and greater health for our communities. We are a Florida licensed health maintenance organization that serves individuals enrolled in Medicaid and/or Medicare programs, 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.
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
  • HS diploma or equivalent;
  • 2+ years experience of Medicare/Medicaid Claims experience; or any combination of education and experience, which would provide an equivalent background.
  • Institutional and professional claims experience is preferred to include claims processing of physician/hospital claims.
  • Excellent oral and written communication skills is preferred.
  • Research, investigate & analytical knowledge is preferred.
  • Strong ability to pay attention to detail is preferred.
  • Previous experience using PC, database system, and related software (word processing, spreadsheets, etc.).
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2018 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.

 

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