Anthem, Inc. Fin Ops Recovery Spec II in Cincinnati, Ohio
SHIFT: Day Job
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.
Fin Ops Recovery Spec II
Responsible for the discovery, validation, processing, recovery, and adjustments of claims payments. May do all or some of the following in relation to claim audits, claim payment corrections, overpayment validation, and claim adjustments
Primary duties may include, but are not limited to:
• Reviews and validates PrePayment claims for potential savings opportunities using various techniques including systems-based queries, specialized reporting and/or other research. • 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.
H.S. diploma or GED
Minimum of 2 years of claims processing and/or customer service experience; or any combination of education and experience, which would provide an equivalent background. AA/AS or higher level degree preferred.
1-2 years of WGS preferred.
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.