Financial Operations Recovery Specialist I/II/III

Elevance Health•Atlanta, GA

1d•Hybrid

About The Position

The Financial Operations Recovery Specialist I/II/III 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 requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. 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 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.