Build the Possibilities. Make an extraordinary impact.
Verification OHI Specialists are responsible for researching and investigating other coverage for GBD membership and for ensuring members Other Health Insurance (OHI) information investigation results are applied accurately into appropriate systems for claims coordination and recovery efforts. Level III specialists will handle complex verifications.
How you will make an impact:
As a Level I Specialist:
- Conducting on-line or on the phone research to verify member's coverage.
- Maintains knowledge of state or carrier specific processing rules.
- Collaborates with multiple internal departments to verify OHI leads and analyzes requests in combination with current system inputs to ensure record is updated accurately.
- Interface with members via external mailings to obtain needed information.
As a Level II Specialist:
- Must be able to successfully perform all the duties of the Verification OHI Specialist I
- 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.
As a Level III Specialist:
- Must be able to successfully perform all the duties of the Verification OHI Specialist I and II
- Handles complex case research and resolution, including but not limited to Employer Group Retirement (EGR) and Medicaid Medicare Programs (MMP).
- Writes and edits procedure documents.
- Assist leadership in identifying opportunities for data integrity and process improvement.
- Researches complex scenarios.
- May assist with training of OHI Verification Specialists and support associate audit process.
This position may be filled as either a Level I, Level II or Level III Specialist; final determination of level to be decided by hiring manager.
- Level I: 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.
- Level 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.
- Level 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 Experiences:
- AA/AS preferred for all levels.
- Previous work experience in a high-performance culture production environment with metrics for both quality (accuracy) and production volume is preferred for all levels.
- Strong foundational knowledge of Medicare/ Medicaid and health insurance for all levels.
Applicable to Colorado Applicants Only
Hourly Pay Range*: $14.42/hr- 18.03/hr (Level I); $15.96/hr - $19.95/hr (Level II); $17.69/hr- $22.12/hr (Level III)
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
* The hourly or salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
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 careers.ElevanceHealthinc.com. 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 email@example.com for assistance.