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Claims Rep I/Ii/Iii (Health & Dental) Midland, GA; Richmond, VA

Expired Job

Anthem, Inc. Midland , GA 31820

Posted 2 months ago

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 benefits companies and a Fortune Top 50 Company.

Claims Representative I-III (Health & Dental)

  • Manager will determine level based upon the selected applicant's skillset relative to the qualifications listed for this position.*

Please note:

Claims Rep I- 2 openings in Midland, GA and/or Richmond, VA

Claims Rep III- 1 opening in Richmond, VA only

Level I:

Successfully completed 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.

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.

AnEqualOpportunityEmployer/Disability/Veteran

Level I:

  • High School diploma or GED;

  • up to 1 year of related experience;

  • or any combination of education and experience, which would provide an equivalent background.

  • Good oral and written communication skills;

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

  • CHIPS knowledge is required

  • B2 knowledge is preferred.

Level II:

  • High School diploma or GED;

  • 1 to 3 years 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.

  • Knowledge of CHIPS, 837, AIMS, ANSIR, and FileNet required.

  • B2 knowledge is preferred.

  • Experience in Professional and/or Facility claim processing is preferred.

Level III:

High School diploma or GED;
3 to 5 years of Anthem, Inc. claims experience; or any combination of education and experience, which would provide an equivalent background.

Knowledge of CHIPS, 837, AIMS, ANSIR, and FileNet required.

B2 knowledge is preferred.

Experience in Professional and/or Facility claim processing is preferred.

CHIPS professional and facility claims Processing

Strong knowledge of COVA claims

Previous Claims Rep II/ III

Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2016 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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Claims Rep I/Ii/Iii (Health & Dental) Midland, GA; Richmond, VA

Expired Job

Anthem, Inc.