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Financial Ops Recovery Specialist I, II, III (PS36039)

Location:
Wilmington, DE
Company:
Anthem, Inc

Description

Description
SHIFT: Day Job
SCHEDULE: Full-time
Financial Operations Recovery Specialist I, II, III
This position can sit onsite in any Anthem office or remote. This position can be filled at the level I, level II or level III position and depends on experience and is up to the managers discretion. This role will support processing of recoveries on the WGS platform.
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.
Financial Operations Recovery Specialist III
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.
- 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 Operations Recovery Specialist 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
- Proficient in Microsoft Office
- Current working knowledge using WGS is an asset.
- Previous experience in high-volume operations (claims, customer service, enrollment and billing)
Financial Operations Recovery Specialist 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.
- Proficient in Microsoft Office.
- Current working knowledge using WGS is an asset.
- Previous experience in high-volume operations (claims, customer service, enrollment and billing)
Financial Operations Recovery Specialist III
- Requires accurate balancing of all accounts.
- Requires a H.S. diploma; 4-5 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.
- Proficient in Microsoft Office
- Current working knowledge using WGS is an asset.
- Previous experience in high-volume operations (claims, customer service, enrollment and billing)
AnEqualOpportunityEmployer/Disability/Veteran
REQNUMBER: PS36039
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