Financial Operations Recovery Specialist II

Location: San Juan, PR. Candidates are required to live in Puerto Rico. Hybrid 1: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. 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. MMM Holdings, LLC is a company that provides Medicare Advantage and Medicaid plans in Puerto Rico. Currently, MMM Holdings, LLC operates in Puerto Rico under Elevance Health, Inc. a leading health company dedicated to improving the quality of life of communities in the United States. Through its affiliated companies, they serve more than 118 million people. The Financial Operations Recovery Specialist II will be 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. How You Will Make An Impact Audits paid claims for overpayments using various techniques including systems-based queries, specialized reporting, or other research.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 and accounts receivable processes and all other cash applications as required.Researches voluntary refunds for accuracy.Requires accurate balancing of all accounts. Minimum 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. Preferred Skills, Capabilities And Experiences AA/AS or higher level degree preferred.Medical billing certification strongly preferred.MS Office Excel and Word and managing SQL strongly preferred.