Claims Customer Service Representative (myNEXUS)
Company: Anthem, Inc
Posted on: January 9, 2022
SHIFT: Day Job
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
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.
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
+ Responsible for incoming and outgoing calls regarding claim
denials or payments.
+ Manages the Claims Operations phone queue during business
+ 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
+ Research's and assists team and management with claim projects,
claims processing discrepancies, eligibility issues and claim
+ Supports Claims Operation team in claims processing
+ Successful in meeting department production and quality standards
+ Acts with honor and integrity, serving as a representative for
+ Respects and maintains HIPAA confidentiality guidelines.
+ Assist with other responsibilities or duties as needed.
+ Adheres to dress code, appearance is neat and clean.
+ Reports to work on time and as scheduled, completes work within
+ Follows all company policies related to time records.
+ Attends annual review and department in-services, as
+ 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
+ Actively participates in performance improvement and continuous
quality improvement (CQI) activities.
+ Complies with all organizational policies regarding ethical
+ Communicates and demonstrates the mission, ethics and goals of
the facility, as well as the focus statement of the department.
Educational & Experience Requirements:
+ Associate's degree in a related field or equivalent relevant work
+ Knowledge of medical terminology, health insurance plans, medical
+ Minimum 2 years of experience in a managed care and claims.
+ Previous experience in Call Center production environment
+ Previous experience in production environment required.
+ 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 careers.antheminc.com. 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
Keywords: Anthem, Inc, Modesto , Claims Customer Service Representative (myNEXUS), Sales , Modesto, California
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