07 Aug
Financial Ops Recovery Specialist I, II (PS38041)
Texas, El paso

Description SHIFT: Day JobSCHEDULE: Full-timeFinancial Operations Recovery Specialist I, IIThis position can sit onsite in any Anthem office or remote. This position can be filled at the level I, or level II position and depends on experience and is up to the managers discretion.Financial Operations 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 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.

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

One year minimum of WGS claims processing experience required.

Current working knowledge using WGS required.

WGS business experience (not specific to ITS) is strongly preferred.

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.

One year minimum of WGS claims processing experience required.

Current working knowledge using WGS required.

WGS business experience (not specific to ITS) is strongly preferred.

AnEqualOpportunityEmployer/Disability/Veteran

REQNUMBER: PS38041


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