Financial Operations Recovery Specialist I/II/III

Elevance Health•Durham, NC

2d•Hybrid

About The Position

The Financial Operations Recovery Specialist I/II/III is responsible for the discovery, validation, recovery, and adjustments of claims overpayments. This role may involve various tasks related to cash receipts, cash application, claim audits, collections, overpayment vendor validation, and claim adjustments. The position requires associates to be in-office 1-2 days per week, balancing collaboration with flexibility for productivity and work-life balance. Candidates must be within a reasonable commuting distance of the posting location unless an accommodation is granted.

Requirements

Requires a H.S. diploma or equivalent and a minimum of 4 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 with systems such as Facets, CIW, CCert, ACR, Work IQ, BlueSquared, and WGS preferred.

Responsibilities

Audits paid claims for overpayments using various techniques including systems-based queries, specialized reporting, or other research.
Interacts with staff and management from other departments on a regular basis to ensure customer satisfaction.
May work with recovery and collection vendors to validate overpayments, validate vendor invoices and provide feedback to modify queries when needed.
Works closely with contract managers to identify and correct contractual issues, if applicable.
Handles complex case research and resolution.
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.
May review and monitor associates work for quality standards.
May review department policy and procedure manuals for accuracy and works to ensure procedures and polices are accurate and complete.
Assists in special projects to find and prevent overpayments and to identify process improvements.
Completes special projects as assigned with minimal supervision.
Researches voluntary refunds for accuracy.
Requires accurate balancing of all accounts.