Financial Operations Recovery Specialist Lead
Elevance Health

The Financial Operations Recovery Specialist Lead 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, claims audits, collections, overpayment vendor validation, and claims adjustments.

Location: This position will work a hybrid model and require 1 day a week in the Norfolk, VA office.

How you will make an impact:

• Audits paid claims for overpayments, using various techniques, including systems-based queries, specialized reporting, or other research.
  
• Interacts with staff and management from various departments on a regular basis to ensure high quality customer satisfaction.
  
• May work with external vendors and internal data mining to validate overpayments, validate vendor invoices and provide feedback to modify queries when needed.
  
• Works closely with management 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 receivables processes and all other cash applications.
  
• Assists in special projects to find and prevent overpayments or to identify process improvements. Completes special projects with minimum supervision.
  
• Researches voluntary refunds for accuracy.
  
• Requires accurate balancing of all accounts.
  
• Trains new associates and provides on-going training to Financial Ops Processors /Recovery Specialists.
  
• Assists with collecting samples each month from each Recovery Specialists to audit for Quality.
  
• Distributes work to staff and supports management on a daily basis, including maintaining of inventory reports.
  

• Requires a H.S. diploma 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.
  

• AA/AS or higher level degree preferred.