Financial Operations Recovery Specialist I - Remote Eligible

Financial Operations Recovery Specialist I

Location: Norfolk, VA

This role enables associates 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.

Carelon Health is a proud member of the Elevance Health family of brands, offering clinical programs and primary care options for seniors. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery.

The Financial Operations Recovery Specialist I is responsible for setting up and adjusting claims overpayments that have been previously identified. May do all or some of the following in relation to cash receipts, cash application, claim audits, collections, overpayment vendor validation, and claim adjustments.

How you will make an impact:

Primary duties may include, but are not limited to:

• Reviews and validates paid claims for overpayments using various techniques including system-based queries, specialized reporting, or other research.
• Determines and calculates amount of overpayments and processes refunds.
• Researches voluntary refunds for accuracy.
• Requires accurate balancing of all accounts.
• Responsible for more routine issues.
• May work with internal staff from other departments to ensure customer satisfaction.
• May perform collection activities to ensure the recovery of overpayments and maintenance of unprocessed cash and accounts receivable balances and all other cash applications.

Minimum Requirements:

• Requires a H.S. diploma or equivalent and a minimum of 1 year 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.
• FACETS, Macess, and CCERT experienced preferred.