Claims Examiner I
Elevance Health

Job Info

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Claims Examiner I

The Claims Examiner I is responsible for

• During the time spent in this position, the Claims Examiner will develop knowledge in all functions of the Claims Examiner I position.
• Additionally, the associate will develop knowledge on multiple accounts to become proficient in processing and may be assigned to claims, adjustments as required.

How you will make an impact :

• Reviews and evaluates claims for information on which to base payment
• Manually calculates benefit determinations (non-payable categories, savings and payments) and/or re-entering claims using PAC (Pre-Adjudication Correction) process for original and reopened claims to be adjusted.
• Refers to policy overage and benefit limitations information (i.e. medical guidelines, corporate policy, contract provisions, other coverage etc.) to determine the appropriate course of action (i.e. referral to MRU, claim reject, return to submittal etc.).
• Utilizes appropriate reference materials to research information, respond to, and resolve problems.
• Updating, manual processing, adjusts claims and/or records as appropriate.
• Prepares reports and/or logs, as necessary.
• Maintains inquiry tracking appropriately 45

Minimum Requirements:

• Minimum of one (1) year of Anthem Blue Cross medical claims processing experience (internal applicants shall have preference over external applicants) or medical claims processing/or other health insurance or equivalent education.

Preferred Skills, Capabilities & Experiences :

• Familiarity with basic arithmetic computations and data entry.
• Knowledge of medical terminology and codes.
• Effective communication and personal computer skills.

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