Financial Operations Recovery Specialist II

Elevance Health•Norfolk, VA

8d•Remote

About The Position

The Financial Operations Recovery Specialist II is responsible for discovering, validating, recovering, and adjusting claims overpayments. Depending on business needs, the role may involve cash receipts, cash application, claim audit collections, overpayment vendor validation, and claim adjustments. The position audits paid claims for potential overpayments using systems-based queries, specialized reporting, and other research to confirm recoverability and adherence to standard operating procedures and business requirements. It handles more complex matters, including coordination of benefits, Medicare, and medical policies, and works with other departments and contract managers to support customer satisfaction and resolve contractual issues. Duties may also include collecting overpayments, maintaining unprocessed cash, accounts receivable processes and other cash applications, researching voluntary refunds for accuracy, and accurately balancing accounts. The role is based in Virginia and is described as virtually full-time, with in-person training sessions required. Candidates must be within reasonable commuting distance of a posting location unless granted a legally required accommodation. The posted hourly salary range is $23.08 to $34.62. Elevance Health describes a comprehensive benefits package, subject to eligibility requirements.

Requirements

High school diploma or equivalent.
At least 2 years of claims processing and/or customer service experience, or an equivalent combination of education and experience.

Nice To Haves

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

Responsibilities

Audit paid claims for identified overpayments using systems-based queries, specialized reporting, and other research.
Confirm overpayment recoverability and alignment with standard operating procedures and business requirements.
Address complex issues involving coordination of benefits, Medicare, and medical policies.
Work regularly with staff from other departments to ensure customer satisfaction.
Work with contract managers to identify and correct contractual issues when applicable.
Perform collection activities to recover overpayments and maintain unprocessed cash, accounts receivable processes, and other cash applications as required.
Research voluntary refunds for accuracy.
Accurately balance all accounts.
Depending on assigned duties, handle cash receipts, cash application, claim audit collections, overpayment vendor validation, and claim adjustments.