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Anthem, Inc. Financial Operations Recovery Specialist I or II in Hialeah Gardens, Florida

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and 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.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health care companies and a Fortune Top 50 Company.

Financial Operations Recovery Specialist I or II (Job Family)

Please Note: This position will be filled at either the Financial Operations Recovery Specialist I or II level. Manager will determine level based upon the selected applicant’s skillset relative to the qualifications listed for this position.

Work Location: Open to any Anthem Office; open to remote/work-at-home for most qualified applicant

Financial Operations Recovery Specialist I

Responsible for setting up and adjusting claims overpayments that have been previously identified. May do all or some of the following in relation to cash receipts, cash application, claim audits, collections, overpayment vendor validation, and claim adjustments.

Primary duties may include, but are not limited to:

  • Reviews and validates paid claims for overpayments using various techniques including system-based queries, specialized reporting, or other research.

  • Determines and calculates amount of overpayments and processes refunds.

  • Researches voluntary refunds for accuracy.

  • Requires accurate balancing of all accounts. Responsible for more routine issues.

  • May work with internal staff from other departments to ensure customer satisfaction.

  • May perform collection activities to ensure the recovery of overpayments and maintenance of unprocessed cash and accounts receivable balances and all other cash applications.

Financial Operations Recovery Specialist II

Responsible for the discovery, validation, recovery, and adjustments of claims overpayments. May do all or some of the following in relation to cash receipts, cash application, claim audits, collections, overpayment vendor validation, and claim adjustments.

Primary duties may include, but are not limited to:

  • Audits paid claims for overpayments using various techniques including systems-based queries, specialized reporting, or other research. Interacts with staff and management from other departments on a regular basis to ensure customer satisfaction.

  • May work with recovery and collection vendors to validate overpayments, validate vendor invoices and provide feedback to modify queries when needed.

  • Works closely with contract managers to identify and correct contractual issues, if applicable.

  • Handles complex case research and resolution.

  • May perform collection activities to ensure the recovery of overpayments and maintenance of unprocessed cash and accounts receivable processes and all other cash applications as required.

  • May review and monitor associates work for quality standards.

  • May review department policy and procedure manuals for accuracy and works to ensure procedures and polices are accurate and complete.

  • Assists in special projects to find and prevent overpayments and to identify process improvements.

  • Completes special projects as assigned with minimal supervision.

  • Researches voluntary refunds for accuracy.

Qualifications

Qualifications:

Financial Operations Recovery Specialist I

  • Requires a H.S. diploma; 1-2 years of claims processing experience; or any combination of education and experience, which would provide an equivalent background.

  • Associate degree preferred.

  • Minimum 1 year of WGS claims processing experience required.

  • Current working knowledge using WGS required.

  • Experience with ITS (Interplan Teleprocessing System) required.

  • NASCO experience desired.

Financial Operations Recovery Specialist II

  • Requires a H.S. diploma; 2-4 years of claims processing experience; or any combination of education and experience, which would provide an equivalent background.

  • Associate degree or higher level degree preferred.

  • Minimum 1 year of WGS claims processing experience required.

  • Current working knowledge using WGS required.

  • Experience with ITS (Interplan Teleprocessing System) required.

  • NASCO experience desired.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 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.

REQNUMBER: PS41129

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