Indianapolis, Indiana, United States · Hybrid
Anticipated End Date: 2026-07-03 Position Title: Carelon Coordination of Benefits (COB) - Investigator II Job Description: Carelon Coordination of Benefits (COB) - Investigator II Internal Job Title: Financial Operations…
Skills: COB Investigation, Claims Adjudication, Data Analysis, Regulatory Compliance, Medicare Secondary Payer
Carapichaima, Couva-Tabaquite-Talparo, Trinidad and Tobago · Hybrid
$87k–$130k/yr
Anticipated End Date: 2026-07-24 Position Title: Patient Safety DRG Clinical Validation Auditor Job Description: Location: This role enables associates to work virtually full-time, except for required in-person training …
Skills: ICD-10 Coding, DRG Auditing, Clinical Documentation Improvement, Medical Record Review, Claims Auditing
Tampa, Florida, United States · Hybrid
$61k–$77k/yr
Anticipated End Date: 2026-06-30 Position Title: Investigator I Job Description: Investigator I Hybrid 1: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while…
Skills: Claims Analytics, Medical Record Review, Case Management, Fraud Detection, FWA Investigation
Wilmington, Delaware, United States · Hybrid
$85k–$139k/yr
Anticipated End Date: 2026-07-01 Position Title: Actuarial Analyst II Job Description: Actuarial Analyst II Hybrid 1: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connect…
Skills: SQL, Python, VBA, Microsoft Excel, AI Automation Tools
Tampa, Florida, United States · Remote OK
Anticipated End Date: 2026-07-08 Position Title: Nurse Case Manager I Job Description: Telephonic Nurse Case Manager I Location: Virtual: This role enables associates to work virtually full-time, with the exception of re…
Skills: Care Management, Clinical Assessment, Discharge Planning, Multi-State Licensure, Critical Thinking
Tampa, Florida, United States · Hybrid
Anticipated End Date: 2026-07-03 Position Title: Business Change Manager Job Description: Location: Indianapolis IN, Tampa FL, Atlanta GA, Columbus GA, Overland Park KS, Louisville KY, St. Louis MO Hours: Standard Workin…
Skills: Process Improvement, Automation, Data Analysis, Cost Benefit Analysis, Future State Design
Lake Mary, Florida, United States · Hybrid
Anticipated End Date: 2026-07-24 Position Title: Credit and Collection Specialist - Patient Accounts Job Description: Location: T his role requires associates to be in-office 1 - 2 days per week, fostering collaboration …
Skills: Debt Collection, Accounts Receivable, Patient Outreach, Payment Processing, Excel
Metairie, Louisiana, United States · Hybrid
Anticipated End Date: 2026-07-24 Position Title: Behavioral Health Medical Director – Psychiatrist - Louisiana Market Job Description: Behavioral Health Medical Director – Psychiatrist - Louisiana Market Location: This r…
Skills: Utilization Management, Medical Necessity Review, Peer-to-Peer Clinical Reviews, Clinical Operations, Medical Policy Interpretation
Eureka, California, United States · Hybrid
$95k–$171k/yr
Anticipated End Date: 2026-07-17 Position Title: Regional Account Liaison - BioPlus Specialty Pharmacy - Northern California Job Description: Title: Regional Account Liaison - BioPlus Specialty Pharmacy Location(s): Cali…
Skills: Sales Strategy, Account Management, Salesforce, Customer Service, Relationship Building
Danbury, Connecticut, United States · Hybrid
$95k–$164k/yr
Anticipated End Date: 2026-07-17 Position Title: Regional Account Liaison - BioPlus Specialty Pharmacy- CT & Upstate NY Job Description: Title: Regional Account Liaison - BioPlus Specialty Pharmacy Location(s): Connectic…
Skills: Sales Strategy, Account Management, Salesforce, Customer Service, Performance Metrics Analysis
Carpinteria, California, United States · On-site
$24/hr–$36/hr
Anticipated End Date: 2026-07-13 Position Title: Pharmacy Technician III – BioPlus Specialty Pharmacy Job Description: Pharmacy Technician III – BioPlus Specialty Pharmacy Location: CA-CARPINTERIA, 4690 CARPINTERIA AVE, …
Skills: Data Entry, Prior Authorization Processing, Adjudication Troubleshooting, Pharmacy Workflow Management, Grievance and Appeals Resolution
Atlanta, Georgia, United States · Hybrid
Anticipated End Date: 2026-07-07 Position Title: Financial Accounting Analyst Job Description: Financial Accounting Analyst Location: This role requires associates to be in-office 1 - 2 days per week, fostering collabora…
Skills: Financial Accounting, Month-End Close, Account Reconciliation, Statutory Accounting Principles, Advanced Excel
Los Angeles, California, United States · Hybrid
$182k–$298k/yr
Anticipated End Date: 2026-06-30 Position Title: Associate General Counsel - Litigation Job Description: Associate General Counsel - Litigation Location: This role requires associates to be in-office 3 days per week, fos…
Skills: Litigation Management, Legal Advice, Risk Mitigation, Outside Counsel Management, Strategic Partnership
Indianapolis, Indiana, United States · Remote OK
Anticipated End Date: 2026-06-25 Position Title: Specialist Medical Director - Cardiology Job Description: Clinical Operations Medical Director Specialist Carelon Medical Benefit Management Cardiology Specialty Virtual: …
Skills: Medical Necessity Determination, Case Review, Peer-to-Peer Consultation, Utilization Management, Clinical Criteria Application
Atlanta, Georgia, United States · Remote OK
$57k–$90k/yr
Anticipated End Date: 2026-07-03 Position Title: Audit & Reimbursement II Job Description: Audit and Reimbursement II Virtual: This role enables associates to work virtually full-time, with the exception of required in-p…
Skills: Audit Work, Desk Reviews, Data Analysis, Government Auditing Standards, CMS Requirements
Louisville, Kentucky, United States · Hybrid
Anticipated End Date: 2026-07-01 Position Title: Referral Specialist II – Paragon Home Infusion Job Description: Referral Specialist II – Paragon Home Infusion Shift: Mon-Fri 9:00 am-6:00 pm CT Virtual: This role enables…
Skills: Insurance Verification, Medical Terminology, ICD Coding, CPT Coding, Referral Management
Indianapolis, Indiana, United States · Hybrid
Anticipated End Date: 2026-06-30 Position Title: Triage Nurse I - CareBridge Job Description: Triage Nurse I Carebridge Health is a proud member of the Elevance Health family of companies, within our Carelon business. Ca…
Skills: Triage, Care Management, Nursing Process, Clinical Documentation, Patient Education
Tampa, Florida, United States · Hybrid
Anticipated End Date: 2026-07-03 Position Title: Financial Consultant Manager Job Description: Location: Louisville KY, Overland Park KS, Grand Prairie TX, Tampa FL, Atlanta GA, Mason OH, Indianapolis IN Hours: Standard …
Skills: Risk Adjustment, Financial Analysis, Budgeting, Forecasting, Financial Reporting
Indianapolis, Indiana, United States · Hybrid
Anticipated End Date: 2026-06-30 Position Title: Financial Operations Analyst Job Description: Financial Operations Analyst Location: This role enables associates to work virtually full-time, with the exception of requir…
Skills: Data Analysis, Financial Reporting, Balance Sheet Reporting, P&L Reporting, Relational Databases
West Des Moines, Iowa, United States · Hybrid
Anticipated End Date: 2026-07-03 Position Title: Nurse Practitioner 100% Virtual, CareBridge Job Description: CareBridge Advanced Practice Provider, Nurse Practitioner Sign-On Bonus: $5,000 * Seeking Nurse Practitioners …
Skills: Complex Care Management, Telehealth, Clinical Care Planning, Patient Education, Electronic Medical Records
Indianapolis, Indiana, United States • Hybrid
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Conduct thorough investigations into potential other coverages to determine primacy and ensure seamless coordination of benefits across various clients and lines of business. Manage sensitive communications with stakeholders and rectify incorrectly paid claims to ensure precise adjustments and refund recovery.
Requires a high school diploma and at least 2 years of experience in claims processing or customer service. Preference is given to candidates with COB investigation experience, a degree in healthcare administration, and proficiency in SQL or data analysis tools.
Internal Job Title: Financial Operations Recovery Specialist II
Virtual: 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 an accommodation is granted as required by law.
Carelon, a proud member of the Elevance Health family of companies, is a healthcare services organization that takes a whole-health approach to making care more integrated, personalized, and affordable. We put people at the center—connecting physical, behavioral, social, and pharmacy services, along with clinical expertise, research, operations, and advanced technology to help care work better, together.
Among us are care providers, engineers, data scientists, and other dedicated professionals determined to recover, eliminate, and prevent unnecessary medical-expense spending.
The Carelon COB Investigator II (Financial Operations Recovery Specialist II) is tasked with conducting thorough investigations into potential other coverages, accurately determining primacy, and ensuring seamless coordination of benefits (COB) across multiple vendor clients, employer groups, and government and specialty lines of business. This position mandates proficiency in multi-system data analysis, claims adjudication, and regulatory compliance, handling complex cases beyond automated systems.
Conduct in-depth COB investigations to establish primary and secondary coverage, utilizing NAIC, CMS, MSP, ERISA, and other federal and state regulations.
Analyze comprehensive data sources such as COB Smart, HEW, claims, and membership data to verify coverage and resolve discrepancies.
Navigate and adapt to multiple internal and external client systems with varying claims processing methodologies and requirements.
Initiate and manage sensitive communications with stakeholders including insurance carriers, members, providers, attorneys, CMS, and Medicaid.
Ensure accuracy in membership data updates, enabling correct future claims processing.
Apply client-specific COB methodologies for appropriate claims adjudication and payment reconciliation.
Identify and rectify incorrectly paid claims, ensuring precise adjustments, reprocessing, and refund recovery.
Maintain compliance with vendor SLAs, state and federal guidelines, and employer group contracts.
Perform additional duties as necessary to support vendor operations and client services.
Requires a H.S. diploma or equivalent and a minimum of 2 years of claims processing and/or customer service experience; or any combination of education and experience, which would provide an equivalent background.
At least 2 years of experience in claims processing and customer service highly desired.
2 years of COB investigation experience is desired, with strong understanding and application of Medicare Secondary Payer (MSP), NAIC guidelines, ERISA, and other relevant regulations.
AA/AS or higher level degree in healthcare administration or insurance is preferred.
Proficiency in Microsoft Office Suite, specifically Excel, Word, Outlook, and Teams; experience with claims processing software and SQL/data analysis tools is preferred.
Expertise in Advanced Negotiation & Dispute Resolution, particularly in handling COB appeals and coverage disputes.
Self-motivated with the ability to prioritize and manage high-volume caseloads, adhering to strict SLAs.
Strong team collaboration skills, capable of working effectively within a cross-functional team while also independently managing investigations.
Exceptional attention to detail to ensure claim adjudication accuracy, membership updates, and compliance with documentation standards.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
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.
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.
NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.
Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner. Our nearly 100,000 associates serve more than 118 million people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health. We believe that improving health for everyone is possible. It begins by redefining health, reimagining the health system, and strengthening our communities.
Offices: 220 Virginia Ave, Indianapolis, Indiana 46204, US
Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner. Our nearly 100,000 associates serve more than 118 million people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health. We believe that improving health for everyone is possible. It begins by redefining health, reimagining the health system, and strengthening our communities.
Offices: 220 Virginia Ave, Indianapolis, Indiana 46204, US
