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Financial Operations Recovery Specialist I, II

Location:
JobFamily: Accounting/Finance/Auditing
Req #: PS53624
Date Posted: Sep 24, 2021

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Description:

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.

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: 

Reviews and validates PrePay claims for potential savings opportunities.

•    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. 
 

Qualifications

 LEVEL I
•    Requires a High School diploma/GED.
•     1-2 years of WGS claims processing experience; or any combination of education of 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, III
•    Requires a High School Diploma/GED.
•    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.

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.

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 positions.
 

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