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Claims Representative I III Health Dental Columbus GA /

Company Name:
UniCare Life & Health Insurance Company
Job Description
WellPoint is one of the nations leading health benefits companies 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 simplify the connection between health, care, and value for our customers.
Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.
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.
Description
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, govt 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 companys 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.
Job Qualifications
Level I:
HS diploma or equivalent;
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.).
Good math skills required.
Must be able to work independently with minimal supervision.
Experience in the healthcare industry preferred.
Critical thinking/strong analytical skills required.
WGS experience preferred.
Claims Experience preferred.
Good PC skills required.
Level II:
HS 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.
Good math skills required.
Must be able to work independently with minimal supervision.
Experience in the healthcare industry preferred.
Critical thinking/strong analytical skills required.
WGS experience preferred.
Claims Experience preferred.
Good PC skills required.
Level III:
HS diploma;
3 to 5 years of WellPoint claims experience;
or any combination of education and experience, which would provide an equivalent background.
Good math skills required.
Must be able to work independently with minimal supervision.
Experience in the healthcare industry preferred.
Critical thinking/strong analytical skills required.
WGS experience preferred.
Claims Experience preferred.
Good PC skills required.
_WellPoint is ranked as one of Americas Most Admired Companies among health insurers by Fortune magazine, and is a 2013 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at_ _. EOE.M/F/Disability/Veteran._
Once an offer is accepted, all external applicants are subject to a background investigation and if appropriate, drug testing. Offers of employment shall be contingent upon passing both the background investigation and drug testing (if required).
Current WellPoint associates: All referrals must be submitted through the formal associate referral process on WorkNet. Official guidelines for the associate referral program can be found in My HR.

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