Financial Operations Recovery Specialist II
About The Position
The Financial Operations Recovery Specialist II is responsible for discovering, validating, recovering, and adjusting claims overpayments. The role may involve cash receipts, cash application, claim audit collections, overpayment vendor validation, and claim adjustments. The position is based in San Juan, Puerto Rico, and candidates must live in Puerto Rico and be within reasonable commuting distance of the posting location. It follows a hybrid schedule requiring in-office attendance 1–2 days per week. The specialist audits paid claims for overpayments using system-based queries, specialized reports, and other research methods. The role handles more complex matters, including coordination of benefits, Medicare, and medical policies, and collaborates with colleagues across departments and with contract managers. Other duties may include overpayment collection activities, maintaining unprocessed cash and accounts receivable processes, completing cash applications, researching voluntary refunds, and accurately balancing accounts.
Requirements
- High school diploma or equivalent, and at least 2 years of claims processing and/or customer service experience; alternatively, an equivalent combination of education and experience.
- Must live in Puerto Rico and be within reasonable commuting distance of the San Juan posting location, unless an accommodation is granted as required by law.
- Ability to work in the office 1–2 days per week under the hybrid arrangement.
Nice To Haves
- AA/AS degree or higher preferred.
- Medical billing certification strongly preferred.
- Strongly preferred proficiency with MS Office Excel and Word and experience managing SQL.
Responsibilities
- Audit paid claims for overpayments using systems-based queries, specialized reporting, and other research.
- Handle complex issues involving coordination of benefits, Medicare, and medical policies.
- Work regularly with staff in other departments to support customer satisfaction.
- Work with contract managers to identify and correct contractual issues when applicable.
- Perform collection activities to recover overpayments when needed.
- Maintain unprocessed cash and accounts receivable processes and perform other required cash applications.
- Research voluntary refunds for accuracy.
- Accurately balance all accounts.
Benefits
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs (unless covered by a collective bargaining agreement)
- Medical benefits
- Dental benefits
- Vision benefits
- Short-term disability benefits
- Long-term disability benefits
- 401(k) with match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
