Financial Operations Recovery Specialist II Job Norfolk Virginia USA,Healthcare

Anticipated End Date:

Position Title:

Financial Operations Recovery Specialist II

Job Description:

Financial Operations Recovery Specialist II

Location:

This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. 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.

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. 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:

Primary duties may include, but are not limited to:
Audits paid claims for identified over payments using various techniques, including systems-based queries, specialized reporting, or other research, to confirm recoverability and alignment with SOPs and business requirements. 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, accounts receivable processes, and all other cash applications as required. Researches voluntary refunds for accuracy. Requires accurate balancing of all accounts.

Minimum Qualifications:

Requires a 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:

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

For candidates working in person or virtually in the below locations, the salary
* range for this specific position is $23.08 - $34.62 per hour. Location(s):
Virginia. 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.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations.

No amount is wages or compensation until such amount is earned, vested, and…