Financial Operations Recovery Specialist III

About This Role

The Financial Operations Recovery Specialist III is responsible for the discovery, validation, recovery, and adjustments of claims overpayments, ensuring the prevention of unnecessary medical-expense spending for Elevance Health.

Responsibilities

• Audit paid claims for overpayments using various techniques including systems-based queries, specialized reporting, or other research
• Interact with staff and management from other departments on a regular basis to ensure customer satisfaction
• Validate Provider/Member Outstanding checks and Escheat Checks
• Request overpayment (Interest/Prompt Pay)
• Work with recovery and collection vendors to validate overpayment, validate vendor invoices and provide feedback to modify queries when needed
• Work closely with contract managers to identify and correct contractual issues
• Perform collection activities to ensure the recovery of overpayments and maintenance of unprocessed cash and accounts receivable processes
• Review and monitor associates' work for quality standards
• Review department policy and procedure manuals for accuracy and ensure procedures and policies are accurate and complete
• Assist in special projects to find and prevent overpayments and to identify process improvements

Requirements

• H.S. diploma or equivalent
• Minimum of 4 years of claims processing and/or customer service experience

Qualifications

• H.S. diploma or equivalent
• Minimum of 4 years of claims processing and/or customer service experience

Nice to Have

• AA/AS or higher level degree
• 4+ years of claims processing experience with WGS, Facets, CHIPS, CS90, Nasco, BlueSquare systems
• Proficiency in Anthem Claims Recovery (ACR)
• Proficiency in Claims Overpayment Recovery (COR)
• Proficiency in WellPoint Content Frameworkk (WCF)
• Proficiency in Business Distributor System (BDS)
• Proficiency in Check inquiry

Skills

* Required skills

Benefits