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Claims Representative I, II, III (Health & Dental)

  • Job Family: Claims
  • Type: Full time
  • Date Posted:
  • Req #: JR68981





Title: Claims Representative I, II, III

Location:  This position will work in a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations:

  • 21215 Burbank Blvd, Woodland Hills, CA
  • 12898 Towne Center Dr, Cerritos, CA
  • 3090 Bristol St, Costa Mesa, CA
  • 11030 White Rock Rd, Rancho Cordova, CA
  • 1121 L St, Sacramento, CA 

Our next training class starts on 6/20/2023

Claims Representative I 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.

Claims Representative II/III is responsible for keying, processing, and/or adjusting health claims in accordance with claims policies and procedures. Works without significant guidance w/ a basic understanding of multiple products (HMO, PPO, COB, etc.).

How you will make an impact: ​ 

Claims Representative I:

  • 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 claim forms for payment ensuring all information is supplied before eligible payments are made.
  • Researches and analyzes claims issues.

Claims Representative II:

  • Able to handle more complex claims with a good understanding of the application of benefit contracts, pricing, processing, policies, procedures, government regs, coordination of benefits,& healthcare terminology.
  • Good working knowledge of claims and products, including the grievance and/or reconsideration process. Excellent knowledge of the various operations of the organization, products, and services.
  • Reviews, analyzes and processes claims/policies related to events to determine the extent of the company's liability and entitlement.
  • Responds to inquiries, may involve customer/client contact.

Claims Representative III:

  • Participate in claims workflow projects.
  • Responds to telephone and written inquiries and initiates steps to assist callers regarding issues relating to the content or interpretation of benefits, policies and procedures, provider contracts, and adjudication of claims.
  • Adjusts voids and reopens claims online within guidelines to ensure proper adjudication.
  • May have customer/client contact.
  • May assist with training of staff.
  • Works without significant guidance.

Minimum requirements:

Claims Representative I:

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

Claims Representative II:

  • HS diploma or equivalent
  • 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.

Claims Representative III:

  • HS diploma
  • Minimum of 3 years of the company's internal claims experience; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

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

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $15.79 to $33.78

Locations:  California; Colorado; Nevada; Washington State; Jersey City, NJ; New York City, NY; Ithaca, NY and Westchester County, NY

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). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company.  The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .

* 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. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at 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 for assistance.

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