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 Job Responsibilities The Claims Representative II is responsible for keying, processing health claims in accordance with claims policies and procedures. Works without significant guidance with a 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 Salary and Location For candidates working in person or virtually in the below locations, the salary range for this position is $17.24 to $29.57. Location(s): New York Benefits In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). Hiring Requirements Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority. We require all new candidates in certain patient/member‑facing roles to become vaccinated against COVID‑19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Equal Employment Opportunity Statement Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact View email address on click.appcast.io for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration ( #J-18808-Ljbffr