Financial Operations Recovery Specialist I

Anticipated End Date:

2025-12-22

Position Title:

Financial Operations Recovery Specialist I

Job Description:

Be Part of an Extraordinary Team

Carelon is a proud member of the Elevance Health family of companies providing unparalleled level of service in pharmacy benefits. By leveraging the power of new technologies, our strong, clinical-first lens and deep pharmacy expertise, we are actively defining our innovative role in the industry. 

Build the Possibilities. Make an Extraordinary Impact.

Title: Financial Operations Recovery Specialist I

Location(s): Columbus, GA, Atlanta, GA, Mason, OH, Indianapolis, IN, Richmond, VA, Miami, FL

Virtual: 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. Alternate locations may be considered. Alternate locations may be considered if candidates reside within a commuting distance from an office.

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 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.

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:

• Strong medical claims processing experience highly preferred.

• Proficient in Microsoft Excel

• AA/AS preferred.

Job Level:

Non-Management Non-Exempt

Workshift:

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