Claims Representative II (Health & Dental)

Claims Representative II (Health & Dental)

Claims Representative II Location: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Hours: Monday through Friday 8 AM to 4:30 PM Eastern

The Claims Representative II is responsible for keying, processing health claims in accordance with claims policies and procedures. Works without significant guidance w/ basic understanding of multiple products (HMO, PPO, COB, etc.). How you will make an impact:

• Able to handle more complex claim with a good understanding of the application of benefit contracts, pricing, processing, policies, procedures, government regs, coordination of benefits, healthcare terminology and/or adjust claims.
• 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.

Minimum Qualifications:

• Requires a HS diploma or equivalent and a minimum of 1 year 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.

Preferred Skills, Capabilities and Experiences:

• System knowledge in some or all of the following is strongly preferred: Edifec, CAS, Service Connect, FlexCare, Vault

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $17.24 to $29.57

Location(s): New York