Job Family: Finance and Actuarial
Type: Full time
Date Posted: Dec 12, 2023
Reference: JR97768
Description
Location: Candidate must be within a 1 hour commute to an Elevance Health Office (approximately 50 Miles)
Hybrid Strategy: 1-2 Days/Week in office (Hybrid 1)
The Financial Operations Recovery Specialist Lead is responsible for CSBD PrePay discovery, validation and processing. May be responsible for recovery and adjustments of claims overpayments and corrections. May do all or some of the following in relation to PrePay processing, claims audits, claims validation, and claims adjustments.
How you will make an impact:
Audits paid claims for accurate processing and/or overpayments, using various techniques, including systems-based queries, specialized reporting, or other research.
Interacts with staff and management from various departments on a regular basis to ensure high quality customer satisfaction.
May collaborate with internal partners to validate claim payments, overpayments, and provide feedback to modify queries when needed. Works closely with management to identify and correct contractual issues, if applicable .
Handles complex case research and resolution.
Assists in special projects to find and prevent overpayments or to identify process improvements.
Completes special projects with minimum supervision.
Trains/mentors new associates and provides on-going training to Financial Ops Processors /Recovery Specialists.
Distributes work to staff and supports management on a daily basis, including maintaining of inventory reports.
Requires a H.S. diploma and minimum of 4 years claims processing and/or customer service experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills & Abilities:
AA/AS or higher level degree
WGS Claims processing and claims research experience
Ability to analyze workflows, processes, and procedures, identifying improvements and/or troubleshoot solutions
Strong and accurate oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Ability to work independently
Ability to multi-task
Must be organized and have excellent time-management skills
Experience mentoring associates
Inventory management experience
CSBD PrePay or Overpayment Recovery knowledge and experience
System Enhancement and testing experience
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
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.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.comfor assistance.