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Requires some supervision with claims processing/adjustments and inquiry resolution. Works with internal business partners (Provider Relations, customer service, account management, claims, appeals, etc.
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Preferred Skills, Capabilities and Experiences: Previous experience providing resolution of issues that include but are not limited to: Enrollment/eligibility determinations; credentialing issues; authorization issues; and Claims processing/payment disputes is highly preferred.
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In-depth knowledge of WGS Commercial Claims processing or adjustments is strongly preferred. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate, and prevent unnecessary medical-expense spending.
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Minimum Requirements: Requires a HS diploma or equivalent and a minimum of 1 year of claims processing and/or customer service and a minimum of 1 year coordination of benefits experience; or any combination of education and experience which would provide an equivalent background.
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Job Description :eCOB Specialist ILocation: Hybrid, within 50 miles of an Elevance Health pulse point. The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting.
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Included are processes related to enrollment and billing and claims processing, as well as customer service written and verbal inquiries. Elevance Health operates in a Hybrid Workforce Strategy.
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Works with Query Developers to ensure business requirements are incorporated into query design, completes and coordinates UAT testing on claims identified as potential overpayments. Obtain, interpret, and apply provider and member contract language, company claims policies, and coding guidelines to support prevention opportunities.
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Participates in pre and post implementation audits of providers, claims processing and payment, benefit coding, member and provider inquiries, enrollment & billing transactions and the corrective action plan process.
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Minimum Requirements:Requires a BS/BA; 2+ years related experience in an enrollment and billing, claims and/or customer contact automated environment (preferably in healthcare or insurance sector); or any combination of education and experience, which would provide an equivalent background.
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And external contacts within the other plans to address all Plan claims or appeals issues. The Plan to Plan Service Specialist I is responsible for serving as a single point of contact in responding to all Plan to Plan claims inquiries and resolving related issues.
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Processing Part B clinical claims in MCS.Experience with dental claims and/or procedures is highly desired but not required. Location: This is a virtual position and preferred candidates reside within 50 miles of an Elevance Health PulsePoint location.
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Claims Representative II - 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.
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Requires a high school diploma or GED; a minimum of 3 years of claims processing, customer service, or para-technical helpdesk support experience; or any combination of education and experience, which would provide an equivalent background.
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The Claims Representative II is responsible for keying, processing health claims in accordance with claims policies and procedures. The Claims Representative III is responsible for keying, processing and/or adjusting health claims in accordance with claims policies and procedures.
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Elevance Health supports a hybrid workplace model with pulse point sites (major office) used for collaboration, community, and connection. 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.
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claims processing jobs Company: Elevance Health in Woods-cross, Utah
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