Recovery Specialist Associate - Call Center

Elevance Health•Louisville, KY

23h•Hybrid

About The Position

Carelon, a proud member of the Elevance Health family of companies, is a healthcare services organization that takes a whole-health approach to making care more integrated, personalized, and affordable. We put people at the center—connecting physical, behavioral, social, and pharmacy services, along with clinical expertise, research, operations, and advanced technology to help care work better, together. 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. This role requires associates be in the 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 H.S. diploma or GED preferred, a minimum 2 years of claims or data entry experience; or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

Prior call center experience strongly preferred.
Medical claims processing experience preferred.
Proficiency with Microsoft Office products (Outlook, MS Teams, Excel, PowerPoint and Word) and software programs preferred.
Excellent communications skills both oral and written preferred.
Prior health care experience preferred.
Strong problem-solving skills preferred.

Responsibilities

Identifying, tracking, and reconciling overpayments made to providers and ensuring that recovery is made and reported under general supervision.
Performing all authorized duties in the processing of overpayments allocated to the assigned market consistent with all applicable company and departmental policies.
Effectively supporting the Subrogation Recovery Operations team.
Providing exceptional service to members, providers, group administrators and attorneys who are providing information on, or seeking information about third party/worker’s compensation subrogation files.
Identifying, reviewing, setting up or closing health insurance subrogation claims via phone, fax, email or mail.
For open cases, collecting, recording and verifying member information, pertinent accident details, attorney information and third-party liability information.
Recording detailed and accurate file notes obtained from calls or written correspondence.
Managing high-volume intake calls and correspondence inventory effectively.
Determining membership eligibility using various job aids and membership systems.
Responding to calls, letters, faxes and emails from policyholders, agents, vendors and/or providers.
Showing initiative and resourcefulness in solving problems and meeting customer needs.
Developing relationships with other business units and service partners whose assistance, cooperation and support may be needed.
Adhering to company and department policies and procedures as well as HIPAA regulations.
Performing other duties as requested or assigned.