Financial Operations Recovery Specialist II

Financial Operations Recovery Specialist II

Onsite Requirement : Virtual; This role enables associates to work virtually full-time, with the exception of 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. Schedule : Monday Friday, 8 : 00 AM 5 : 00 PM, time zone depends on candidates specific time zone.

The Financial Operations Recovery Specialist II is responsible for the discovery, validation, recovery, and adjustments of claims overpayments and claim corrections. May do all or some of the following in relation to cash receipts, cash application, claim audits collections, overpayment vendor validation, and claim adjustments and Data Mining PrePay.

How You Will Make an Impact : Primary duties may include, but are not limited to :

• Reviews and validates PrePayment claims for potential savings opportunities using various techniques including systems-based queries, specialized reporting and / or other research.
• 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, & Experiences : WGS / CIW Claims Processing experience strongly desired. Ability and comfortable working in a fast-paced production environment. Ability to meet high quality standards is preferred. Ability to read and follow specific instructions. ITS Home and / or Host experience preferred. AA / AS or higher-level degree preferred.

Who We Are : 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.

How We Work : 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.