Financial Operations Recovery Specialist II

Location: Virtual:
This role enables the associate to work virtually full‑time, with the exception of 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. 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. The role may involve activities related to cash receipts, cash application, claim audits, collections, over payment vendor validation, and claim adjustments. This position is specific to Commercial Pre Pay on WGS. WGS/CI&W experience will be required.

• Audit paid claims for over payments using various techniques including systems‑based queries, specialized reporting, or other research.
• Handle more complex issues such as coordination of benefits, Medicare, and medical policies.
• Collaborate closely with staff from other departments on a regular basis to ensure customer satisfaction.
• Work with contract managers to identify and correct contractual issues when applicable.
• Perform collection activities to ensure recovery of over payments and maintenance of unprocessed cash and accounts receivable processes and all other cash applications as required.
• Research voluntary refunds for accuracy.
• Maintain accurate balancing of all accounts.

• H.S. diploma or equivalent with a minimum of 2 years of claims processing and/or customer service experience; or any combination of education and experience that provides an equivalent background.

• Experience with Commercial Pre Pay on WGS. WGS/CI&W experience is strongly preferred.
• TS Home and/or Host experience preferred.
• Claim Adjustment experience preferred.
• Demonstrated ability to work independently, prioritize workload, and take ownership of daily deliverables with minimal supervision.
• Strong ability to read, interpret, and accurately apply documented policies, procedures, and processing steps to ensure compliant, consistent outcomes.
• Flexibility to shift between work types (e.g., queues, outreach, research, corrections) and adapt quickly to changing priorities while maintaining production and quality standards.
• 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.

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, and local laws.

Applicants who require accommodation to participate in the job application process may contact elevancehealthj for assistance.