Financial Operations Recovery Specialist II

Financial Operations Recovery Specialist II 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 overpayments. May do all or some of the following in relation to cash receipts, cash application, claim audits collections, overpayment vendor validation, and claim adjustments. This position will be specific to Commercial PrePay on WGS. WGS/CI&W experience will be required. How You Will Make An Impact Audits paid claims for overpayments using various techniques including systems-based queries, specialized reporting, or other research. Responsible for more complex issues such as coordination of benefits, Medicare, and medical policies. Works closely with staff from other departments on a regular basis to ensure customer satisfaction. Works closely with contract managers to identify and correct contractual issues when applicable. May perform collection activities to ensure the recovery of overpayments and maintenance of unprocessed cash and accounts receivable processes and all other cash applications as required. Researches voluntary refunds for accuracy. Requires accurate balancing of all accounts. Minimum Requirements Requires a H.S. diploma or equivalent and a minimum of 2 years 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 Experience with Commercial PrePay 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.

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