Sr Credit & Collections Specialist

Sr Credit & Collections Specialist

Location: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

CarelonRx is a proud member of the Elevance Health family of companies. CarelonRx pairs a strong, clinical-first lens with deep pharmacy expertise to create solutions that improve outcomes, control costs, and enhance each member's health.

The Sr Credit and Collections Specialist is responsible for the timely follow up and resolution of outstanding insurance claims to ensure maximum reimbursement and minimized aging accounts receivable. This role works directly with payers, internal billing teams, and operational departments to resolve claim denials, underpayments, and unpaid balances while maintaining compliance with payer and regulatory guidelines.

How you'll make a difference:

• Follows established guidelines, contacts group for the purpose of collecting past due insurance premiums and/or past due health insurance claims.
• Researches validity of past due and/or disputed debt.
• Generates demand letters.
• Prepares reports reflecting status of credit and collection activities for management review.

Minimum Requirements:

• Requires a H.S. diploma or equivalent and a minimum of 2 years of commercial debt collection experience; or any combination of education and experience, which would provide an equivalent background.

Preferred skills, qualifications and experiences:

• Preferred specialty Pharmacy and/or home Infusion experience.
• Medicare and commercial insurance knowledge highly recommended.
• Strong understanding of denial management and reimbursement processes with experience in claim submissions, corrected claims and payer follow up desired.

Job Level: Non-Management Non-Exempt

Workshift: 1st Shift (United States of America)

Job Family: AFA > Financial Operations

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.

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 and Influenza. 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 should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.