Financial Operations Recovery Specialist Lead

Position Title:
Financial Operations Recovery Specialist Lead
Job Description:
Financial Operations Recovery Specialist Lead
This position will work a hybrid model (remote and office), 1-2 times per week. The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.
The Financial Operations Recovery Specialist Lead will be responsible for Commercial Specialty Business Division Post Pay discovery, validation and adjustments. May be responsible for recovery and adjustments of claims overpayments and corrections. May do all or some of the following in relation to processing, claims audits, claims validation, and claims adjustments.
How you will make an impact:

• Audits claims for accurate processing and/or 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 collaborate with internal partners to validate claim payments, overpayments, 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.
• Ability to analyze workflows, processes, and procedures, identifying improvements and/or troubleshoot solutions;
• Assists in special projects to find and prevent overpayments or to identify process improvements.
• Completes special projects with minimum supervision.
• Trains/mentors new associates and provides on-going training to Financial Ops Processors /Recovery Specialists.
• Distributes work to staff and supports management on a daily basis, including maintaining of inventory reports.

Minimum Requirements:

• Requires a H.S. diploma; 4+ 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.
• WGS Claims processing adjustments and claims research experience preferred.
• Requires strong and accurate oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
• Ability to work independently and to multi-task a plus.
• Must be organized and have excellent time-management skills a plus.
• Inventory management experience preferred.
• Commercial Specialty Business Division Overpayment Recovery knowledge and experience preferred.
• System Enhancement and testing experience preferred.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $72,772 to $109,158.
Locations: California, Colorado
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 considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
Job Level:
Non-Management Exempt
Workshift:
1st Shift (United States of America)
Job Family:
AFA >Financial Operations
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.