Financial Operation Recovery Specialist II

Financial Operation 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 accommodation is granted as required by law.

The Financial Operations Recovery Specialist II (US) 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.

How you will make an impact:

• Audits paid claims for overpayments using various techniques including systems-based queries, specialized reporting, or another 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 for receivable processes and all other cash applications as required.
• Research voluntary refunds for accuracy.
• Requires accurate balancing of all accounts.

Minimum Qualifications:

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 degree or higher preferred
• Experience in claims adjustment and/or customer service
• Experience with the following systems:
• CIW
• WGS

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.