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Verification OHI Specialist II

  • Job Family: Customer Care
  • Type: Full time
  • Date Posted:
  • Req #: PS74764


  • National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint



Build the Possibilities. Make an extraordinary impact.
As a Verification OHI Specialist, you will be responsible for researching and investigating other coverage for GBD Medicaid membership and for ensuring members Other Health Insurance (OHI) information investigation results are applied accurately into appropriate systems for claims coordination and recovery efforts.

How you will make an impact:

  • Conduct on-line or phone research to verify member's coverage with other carriers

  • Maintain knowledge of state or carrier specific processing rules

  • Collaborate with multiple internal departments to verify OHI leads and analyzes requests in combination with current system data to ensure record is updated accurately

  • Interface with members via external mailings to obtain needed information

  • Work escalated and critical inventory within required turnaround times

  • Maintain Medicare member Medicare Secondary Payer (MSP)/Coordination of Benefits (COB) records in all applicable systems

  • Assist with special projects, including but not limited to CMS Audits, state and provider complaints and CAV enhancement specific projects

  • Ability to work from spreadsheets and other inventory assignment processes that are outside of daily queue work

  • Handle complex case research and resolution, including but not limited to Employer Group Retirement (EGR) and Medicaid Medicare Programs (MMP)

  • Write and edit procedure documents. 

  • Assist leadership in identifying opportunities for data integrity and process improvement

  • Research complex scenarios. 

  • May assist with training of OHI Verification Specialists and support associate audit process. 

This position can be filled at Verification OHI Specialist, II, or III level. The hiring manager will determine the level, based on the candidate’s experience and background.

Minimum Requirements  

  • Specialist: Requires a HS diploma and a minimum of 1 year of claim or customer service experience; or any combination of education and experience which would provide an equivalent background.

  • Specialist II: Requires a HS diploma and a minimum of 2 years of claims or customer service experience and a minimum of 1 year of coordination of benefits experience; or any combination of education and experience which would provide an equivalent background. 

  • Specialist III: Requires a HS diploma and a minimum of 3 years of Verification OHI Specialist experience; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities, and Experience

  • AA/AS preferred

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

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?

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 Elevance Health. 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 Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health 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 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 for assistance.

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