Financial Ops Recovery Specialist II

Financial Ops Recovery Specialist II

This is a virtual eligible role. You must be within a reasonable distance of one of our eligible offices.

General business hours, Monday through Friday.

Hybrid 1:
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. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, 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.

The Financial Operations Recovery Specialist II is responsible for the discovery, validation, recovery, and adjustments of claims over payments. May do all or some of the following in relation to cash receipts, cash application, claim audits collections, over payment vendor validation, and claim adjustments.

How you will make an impact:

• Audits paid claims for over payments using various techniques including systems-based queries, specialized reporting, or other research.
• 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 over payments and maintenance of unprocessed cash and accounts receivable processes and all other cash applications as required.
• Researches voluntary refunds for accuracy.
• Requires accurate balancing of all accounts.

Minimum Requirements:

• 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.

Preferred Skills, Capabilities, and Experiences:

• Medical claims processing/adjustment experience preferred.
• Experience in Facets preferred.
• Experience in Macess preferred.
• A.A./A.S. preferred.
• Strong ability to read, interpret, and accurately apply documented policies, procedures, and processing steps to ensure compliant, consistent outcomes.
• High attention to detail and accuracy when reviewing financial information, resolving discrepancies, and documenting actions in required systems.
• Effective time management and organization skills to meet deadlines and service-level expectations in a high-volume environment.

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.