Job Description:

Claims Representative I/II (Health & Dental)




Location: Must live within 50 miles of the Norfolk, VA, Mason, OH, Houston, TX, Indianapolis, IN, De Moines, IA, Grand Prairie, TX, Altamonte Springs FL, W Des Moines, IA Miami, FL, or Tampa, FL PulsePoints.


The Claims Representative I/II (Health & Dental) is responsible for successfully completing the required basic training. Able to perform basic job functions with help from co-workers, specialists and managers on non-basic issues. Must pass the appropriate pre-employment test battery.



How you will make an impact:

• Learning 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.

Minimum Requirements:

This position can be filled at Claims Representative I or Claims Representative II level. The Hiring Manager will determine the level, based on the candidate's experience and background.

• 
  Claims Representative I - Requires HS diploma or equivalent and related experience; or any combination of education and experience which would provide an equivalent background.


• 
  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.); or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

• Medicaid claims experience highly preferred.


• Call center preferred.


• Good oral and written communication skills, previous experience using PC, database system, and related software (word processing, spreadsheets, etc.) strongly preferred.

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