Anthem Financial Operations Recovery Specialist III - USA - PS2516 in Turlock, California

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 benefits companies and a Fortune Top 50 Company.


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.

  • 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.

  • 5 years of WGS Processing Required

  • 2 years ACR preferred

  • 2 years COR preferred

  • Associate degree or higher level degree preferred.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at EOE. M/F/Disability/Veteran.

Job Accounting/Finance/Auditing

Equal Employment Opportunity Statement Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.

Title: Financial Operations Recovery Specialist III - USA - PS2516

Location: california-Turlock

Requisition ID: PS2516