Elevance Heath
The Recovery Specialist Associate is responsible for identifying, tracking, and reconciling overpayments made to providers and ensuring that recovery is made and reported under general supervision. Performs all authorized duties in the processing of overpayments allocated to the assigned market consistent with all applicable company and departmental policies.
Primary duties may include, but are not limited to:
- Processes daily provider refund checks and adjustment requests from overpayment projects.
- Interprets policy provisions to accurately process overpayment adjustments in accordance with department policies.
- Maintains working knowledge of all company products and services pertaining to business segment.
- Works with health plans regarding overpayment Provider disputes.
- Communicates with Providers regarding overpayment disputes on occasion.
- Adheres to company and department policies and procedures as well as HIPAA regulations.
- Effectively support the Subrogation Recovery Operations team.
- Provides exceptional service to member, providers, group administrators and attorneys who are providing information on, or seeking information about third party/worker’s compensation subrogation files.
- Identifies, reviews, sets up or closes health insurance subrogation claims via phone, fax, email or mail. For open cases, collects, records and verifies member information, pertinent accident details, attorney information and third-party liability information. Records detailed and accurate file notes obtained from calls or written correspondence.
- Manage high-volume intake calls and correspondence inventory effectively.
- Determine membership eligibility using various job aids and membership systems.
- Responds to calls, letters, faxes and emails from policyholders, agents, vendors and/or providers
- Show initiative and resourcefulness in solving problems and meeting customer needs.
- Develop relationships with other business units and service partners whose assistance, cooperation and support may be needed.
- Performs other duties as requested or assigned.
Qualifications – External
Primary requirements:
- 2 years of experience in claims and/or customer service or data entry experience; or any combination of education, which would provide an equivalent background
- Proficiency with Microsoft Office products (Outlook, MS Teams, Excel, PowerPoint and Word) and software programs
- Excellent communications skills both oral and written.
Preferred requirements:
- H.S. diploma or GED preferred.
- Medical claims processing experience preferred.
- Prior health care experience.
- Requires strong problem-solving skills
- Experience with Medicare/Medicaid claims.
- Experience with using a document management system.
Applicable to Colorado Applicants Only
Hourly Pay Range*: $14.88/hr – $19.54/hr (Min – MRP)
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
* The hourly or 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. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. 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 Non-Exempt
Workshift:
Job Family:
AFA > Financial Operations
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.