Financial Operations Recovery Specialist I

Elevance Health•Durham, NC

4d•$20 - $36•Remote

About The Position

The Financial Operations Recovery Specialist I is responsible for setting up and adjusting claims overpayments that have been previously identified. May do all or some of the following in relation to cash receipts, cash application, claim audits, collections, overpayment vendor validation, and claim adjustments. 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. 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.

Requirements

Requires a H.S. diploma or equivalent and a minimum of 1 year of claims processing and/or customer service experience; or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

AA/AS preferred.
Previous claims experience and/or experience within the healthcare/health insurance industry is preferred.
Candidates in alternate locations may apply, considering they are within a reasonable commuting distance of an Elevance Pulse Point office.

Responsibilities

Reviews and validates paid claims for overpayments using various techniques including system-based queries, specialized reporting, or other research.
Determines and calculates amount of overpayments and processes refunds.
Researches voluntary refunds for accuracy.
Requires accurate balancing of all accounts.
Responsible for more routine issues.
May work with internal staff from other departments to ensure customer satisfaction.
May perform collection activities to ensure the recovery of overpayments and maintenance of unprocessed cash and accounts receivable balances and all other cash applications.