Financial Operations Recovery Specialist II
Core
Audits paid claims for identified overpayments using systems-based queries and specialized reporting to confirm recoverability and alignment with SOPs.
Role type
Financial Operations Recovery Specialist
Builds
Cash receipts, cash application, claim audits collections, overpayment vendor validation, and claim adjustments
Domain
Healthcare / Insurance Claims
Required skills
Claims processing, Customer service, Post-pay claim validation, Claims recovery, Accounts receivable (AR) processes, Medical claims knowledge, Medicare coordination, Contractual issue identification, Discrepancy identification, Escalation process adherence
Preferred skills
AA/AS or higher degree, High-volume production environment experience, Claims systems knowledge, Medical coding knowledge
Technologies
Claims systems, Specialized reporting tools
Responsibilities
Audits paid claims for identified overpayments using various techniques including systems-based queries and specialized reporting. Coordinates benefits, Medicare, and medical policies. Works with contract managers to identify and correct contractual issues. Performs collection activities to ensure recovery of overpayments. Researches voluntary refunds for accuracy. Balances all accounts accurately.
