Claims Representative I, II, III -Albany - (US-NY-Albany - 12288)

Minimum Education: Tech School
Job Type: Full Time
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Empire BlueCross BlueShield is a distinguished leader in the health insurance industry and part of the WellPoint family of companies. As we build on our 70-year history serving the health insurance needs of New York State, we are focused on becoming indispensable to the customers and communities we serve and providing a rewarding career for our talented and diverse workforce.

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.

The Claims Representative I
will learn 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.

The Claims Representative II
will key, process and/or adjust 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.

Skills:
Claims Representative I* Good oral and written communication skills.* Requires HS diploma or equivalent.* 0-1 years related experience or any combination of education and experience, which would provide an equivalent background. Claims Representative II* Requires HS diploma.* 9 months claims experience.* Good oral and written communication skills.* 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. Claims Representative III* Requires HS diploma.* 2 years claims 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.) WellPoint is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2009 DiversityInc magazine Top 50 Company for Diversity.

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