Financial Operations Recovery Specialist II

About the role

The Financial Operations Recovery Specialist II is 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.

Responsibilities

• Audits paid claims for identified overpayments using various techniques, including systems-based queries, specialized reporting, or other research, to confirm recoverability and alignment with SOPs and business requirements.
• Responsible for more complex issues such as coordination of benefits, Medicare, and medical policies.
• Works closely with staff from other departments on a regular basis to ensure customer satisfaction.
• Works closely with contract managers to identify and correct contractual issues when applicable.
• May perform collection activities to ensure the recovery of overpayments and maintenance of unprocessed cash, accounts receivable processes, and all other cash applications as required.
• Researches voluntary refunds for accuracy.
• Requires accurate balancing of all accounts.

Requirements

• 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.

Skills

• AA/AS or higher level degree preferred.
• Experience performing post-pay claim validation on claims to confirm recoverable overpayments strongly preferred.
• Experience in claims recovery, overpayment identification, or accounts receivable (AR) processes strongly preferred.
• Experience working in a high-volume, production-based claims environment preferred.
• Strong attention to detail with the ability to meet productivity and quality benchmarks preferred.
• Knowledge of claims systems, edits, and validation workflows preferred.
• Familiarity with medical claims, including Medicare, coordination of benefits (COB), and medical policy review preferred.
• Ability to identify discrepancies and follow defined escalation processes preferred.
• Knowledge in medical coding preferred.

Pay

For candidates working in person or virtually in Virginia, the salary range for this specific position is $23.08 - $34.62 per hour.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401(k) contribution (with match)
• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs (unless covered by a collective bargaining agreement)
• Medical, dental, and vision benefits
• Short and long term disability benefits
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources

All benefits are subject to eligibility requirements.

Schedule

This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. Alternate locations may be considered if candidates reside within a commuting distance from an office. Per 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. Elevance Health operates a Hybrid Workforce Strategy; unless specified as primarily virtual by the hiring manager, associates are generally 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.