Financial Operations Recovery Specialist I or II- Remote or In Anthem Office- PS28638

Compensation

: $75,160.00 - $104,340.00 /year *

Employment Type

: Full-Time

Industry

: Financial Services - Insurance



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Financial Operations Recovery Specialist I or II- Remote or In Anthem Office- PS28638 Location: United States New Requisition : PS28638 Post Date: 1 day ago _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 benefits companies and a Fortune Top 50 Company. The level chosen for this position will be based on experience and qualifications. If the associate selected is in the office, they'll remain in the office until they've met the minimum requirements for remote at that time remote possibility can be reviewed. The Financial Ops Recovery Specialist I is responsible for validating prepayment claims for potential savings opportunities. May also be 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 PrePay claims for potential savings opportunities. 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. The Financial Ops Recovery Specialist II is responsible for validating prepayment claims for potential savings opportunities. May also be 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: Responsibilities of Level I Audits paid claims for overpayments using various techniques including systems-based queries, specialized reporting, or other research. Responsible for more complex issues such as coordination of benefits, Medicare, and medical policies. Works closely with staff from other departments on a regular basis to ensure customer satisfaction. Works closely with contract managers to identify and correct contractual issues when applicable. 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. Researches voluntary refunds for accuracy. Requires accurate balancing of all accounts. LEVEL I Requires a H.S. diploma. 1-2 years of claims processing and/or customer service experience; or any combination of education and experience, which would provide an equivalent background. Associate degree preferred. Current working knowledge using WGS required. WGS professional and facility claims processing/adjustment experience is required. Pricing system knowledge with WGS Stand Alone, ETS Networx Pricer/GA Pricing System, Price N Ship/ Central Networx Pricing, OHAS preferred. LEVEL II Requires a H.S. diploma. 2-4 years of claims processing and/or customer service experience; or any combination of education and experience, which would provide an equivalent background. Associate degree or higher level degree preferred. Current working knowledge using WGS required. WGS professional and facility claims processing/adjustment experience is required. ACR experience is preferred. Pricing system knowledge with WGS Stand Alone, ETS Networx, Pricer/GA Pricing System, Price N Ship/ Central Networx Pricing, OHAS required. Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.
Associated topics: auto, bodily, casualty, claim adjuster, claim investigator, claimant, damage, insurance, investigation, liability * The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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