Anthem Inc. Indianapolis Jobs

Job Information

Anthem, Inc. Financial Operations Recovery Specialist I,II,III in Indianapolis, Indiana

Description

SHIFT: Day Job

SCHEDULE: Full-time

Be part of an extraordinary team

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high performance culture that empowers you to make an impact?

$1000 Sign on Bonus

This is an opportunity to join a growing team with a focus on Data Mining Claims Validation.

As a member of the Prepayment Validation Team, you will review/audit and finalize live claims to ensure accurate application of benefits, pricing and policies for the highest accuracy of claims payments, while helping to reduce provider and member abrasion.

As a member of the Post Payment Validation Team, you will review/audit and adjust finalized claims to ensure accurate application of benefits, pricing and policies in order to accurately correct payment and request overpayments.

Level I

You will be 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 Pre-Payment or Post-Payment 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.

  • May do follow up collection activities to ensure the recovery of overpayments through Host Plans.

  • May require verification with host plans adjusting claims through the ITS and WGS systems

Level II

  • All of Level I plus:

  • Responsible for more complex issues such as coordination of benefits, Medicare, and medical policies, more advanced concepts including correcting ITS Home claims

  • May work projects and/or emails as assigned by Leads.

Level III

  • All of the above plus:

  • 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.

  • Identify and present opportunities for team and/or concept improvements

  • May work with BA’s and other teams on concept improvements and/or documentation improvements

  • Mentor/train/shadow new hires

  • May participate in issue discussions for resolutions

Qualifications

Level I

Required Qualifications

  • Highschool Diploma

  • 1 year of medical claims processing experience and/or customer service; or any combination of education and experience, which would provide an equivalent background; i.e. experience from other Health Plans, Hospitals and/or Medical Groups.

Preferred Qualifications

  • AA/AS or higher level degree preferred.

  • Knowledge of ICD10, CPT, and HCPC codes preferred.

  • Member benefit and provider contract language knowledge preferred.

Level II

Required Qualifications

  • High School Diploma

  • 2 years of WGS claims processing experience; or any combination of education and experience, which would provide an equivalent background

Preferred Qualifications

  • AA/AS or higher level degree preferred.

  • Knowledge of ICD10, CPT, and HCPC codes preferred.

  • Member benefit and provider contract language knowledge preferred.

Level III

Required Qualifications

  • High School Diploma

  • 4 years of WGS claims processing experience; or any combination of education and experience, which would provide an equivalent background

Preferred Qualifications

  • AA/AS or higher level degree preferred.

  • Knowledge of ICD10, CPT, and HCPC codes preferred.

  • Member benefit and provider contract language knowledge 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. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem 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 ability@icareerhelp.com for assistance.

REQNUMBER: 0164704

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