Financial Operations Recovery Specialist II

Location: Virtual - This role enables associates to work virtually full-time, with the exception of 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. 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.

About the role

The Financial Operations Recovery Specialist II is responsible for the discovery, validation, recovery, and adjustments of claims overpayments. May perform duties related to cash receipts, cash application, claim audits, collections, overpayment vendor validation, and claim adjustments.

Responsibilities

• Audits paid claims for overpayments using various techniques including systems-based queries, specialized reporting, or other research.
• Handles complex issues such as coordination of benefits, Medicare, and medical policies.
• Works closely with staff from other departments to ensure customer satisfaction.
• Collaborates with contract managers to identify and correct contractual issues when applicable.
• May perform collection activities to ensure recovery of overpayments and maintenance of unprocessed cash and accounts receivable processes.
• Researches voluntary refunds for accuracy and requires accurate balancing of all accounts.

Requirements

• High School diploma or equivalent.
• 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 Qualifications

• AA/AS or higher-level degree.
• Commercial & Government claims adjustment experience.
• WGS and/or Facets experience.

Benefits

• 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) with company match, stock purchase plan, life insurance.
• Wellness programs and financial education resources.

Schedule

Hybrid Workforce Strategy: 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.

Elevance Health is an Equal Employment Opportunity employer. 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.