Financial Ops Recovery Specialist I, II

Description SHIFT: Day JobSCHEDULE: Full-timeFinancial Operations Recovery Specialist I, IIThis position can be filled at either the level I or level II depending on experience. This position will sit onsite in an Anthem office (once offices are back open) with the possibility for remote.Financial Ops Recovery Specialist IResponsible 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 Ops Recovery Specialist IIResponsible 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 adjustmentsPrimary 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.

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 Financial Ops Recovery Specialist IIRequires 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.

Financial Ops Recovery Specialist IIRequires 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.

AnEqualOpportunityEmployer/Disability/VeteranREQNUMBER: PS43066