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Claims Customer Service Representative (myNEXUS)

Company: Anthem, Inc
Location: Modesto
Posted on: January 9, 2022

Job Description:


SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At myNEXUS, a proud member of the Anthem, Inc. family of companies, it's a powerful combination. It's the foundation upon which we're creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.

myNEXUS is a technology-driven, care and benefit management service that enables individuals to live healthier lives in their homes. Our proven clinical model connects individuals to intelligent care delivering independence at lower costs. To maximize health delivery, we consistently leverage our: Innovative Technologies, Advanced Clinical Expertise, and Proprietary Network Engagement Platform. We are continuously pioneering ways to optimize health resources for our clients and their customers. Through our proprietary network management and engagement programs, we realize enhancements in quality, outcomes, and care effectiveness.

Job Summary:

The Client Service Representative is responsible for interacting with medical offices, and health plans to provide and obtain information in response to inquiries regarding claim submissions, denials and other claims related requests.


+ Answers incoming and places outbound phone calls from/to providers regarding status of claim requests and answers general questions.

+ Responsible for incoming and outgoing calls regarding claim denials or payments.

+ Manages the Claims Operations phone queue during business hours.

+ Meets designated timeframes to fulfill clients' requests when communicating with Provider's offices or Health Plans.

+ Provides effective customer service to our clients by appropriately responding to emails, phone calls and/or any communication regarding requested information.

+ Maintains consistent attendance to meet daily call center performance goals.

+ Research's and assists team and management with claim projects, claims processing discrepancies, eligibility issues and claim rejections.

+ Supports Claims Operation team in claims processing activities.

+ Successful in meeting department production and quality standards and goals.

+ Acts with honor and integrity, serving as a representative for the company.

+ Respects and maintains HIPAA confidentiality guidelines.

+ Assist with other responsibilities or duties as needed.

Professional Requirements:

+ Adheres to dress code, appearance is neat and clean.

+ Reports to work on time and as scheduled, completes work within designated time.

+ Follows all company policies related to time records.

+ Attends annual review and department in-services, as scheduled.

+ Attends staff meetings as scheduled and reads all staff meeting minutes and other written documents as requested.

+ Represents the organization in a positive and professional manner.

+ Actively participates in performance improvement and continuous quality improvement (CQI) activities.

+ Complies with all organizational policies regarding ethical business practices.

+ Communicates and demonstrates the mission, ethics and goals of the facility, as well as the focus statement of the department.

Required Skills/Abilities:

Educational & Experience Requirements:

+ Associate's degree in a related field or equivalent relevant work experience.

+ Knowledge of medical terminology, health insurance plans, medical billing concepts.

+ Minimum 2 years of experience in a managed care and claims.

+ Previous experience in Call Center production environment preferred.

+ Previous experience in production environment required.

Language Skills:

+ Ability to read and communicate effectively in English.

+ Additional languages preferred.


+ Proficient computer knowledge such as Word and Excel.

+ Excellent communication skills and telephone etiquette.

+ Ability to work accurately and efficiently.

+ Ability to interact effectively and in a supportive fashion with persons of all backgrounds.

+ Data entry and basic calculations.

+ Self-starter with ability to work independently.

+ Ability to sit for extended periods and read monitors.

+ Strong attention to detail.

Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For , is ranked as one of the 2020 World's Most Admired Companies among health insurers by Fortune magazine, and a 2020 America's Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.


Keywords: Anthem, Inc, Modesto , Claims Customer Service Representative (myNEXUS), Sales , Modesto, California

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