Financial Operations Recovery Specialist II

Elevance Health•Atlanta, VA

1d•Remote

About The Position

The Financial Operations Recovery Specialist II 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. 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. Among us are specialty-care physicians, nurse practitioners, pharmacists, engineers, data scientists, and other dedicated and caring health professionals. While our roles may differ, our purpose is shared: to make a positive impact on whole health.

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.

Nice To Haves

AA/AS or higher level degree preferred.
Experience performing post-pay claim validation on claims to confirm recoverable overpayments strongly preferred.
Experience in claims recovery, overpayment identification, or accounts receivable (AR) processes strongly preferred.
Experience working in a high-volume, production-based claims environment preferred.
Strong attention to detail with the ability to meet productivity and quality benchmarks preferred.
Knowledge of claims systems, edits, and validation workflows preferred.
Familiarity with medical claims, including Medicare, coordination of benefits (COB), and medical policy review preferred.
Ability to identify discrepancies and follow defined escalation processes preferred.
Knowledge in medical coding preferred.

Responsibilities

Audits paid claims for identified overpayments using various techniques, including systems-based queries, specialized reporting, or other research, to confirm recoverability and alignment with SOPs and business requirements.
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, accounts receivable processes, and all other cash applications as required.
Researches voluntary refunds for accuracy.
Requires accurate balancing of all accounts.