Claims Rep I/II - 42623

WellPoint is the nation';s leading health benefits insurer and a Fortune Top 50 company. At WellPoint, we are dedicated to improving the lives of the people we serve and the health of our communities. WellPoint strives to be the most trusted choice for consumers and a leader in affordable quality care with an unyielding commitment to meeting the needs of our diverse customers.  Bring your expertise to our innovative, performance-focused culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine. 

We are seeking a Claims Rep I or II (depending on experience) that will be located in our Mason, OH office.  

 

Claims Rep I  

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. Primary duties may include, but are not limited to: codes and processes claims forms for payment ensuring all information is supplied before eligible payments are made. Researches and analyzes claims issues. Good oral and written communication skills. 

 

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.). Able to handles 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. Primary duties may include, but are not limited to: 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.