Claims Recovery Specialist I (Remote)

About the role

Under direct supervision, the Claims Recovery Specialist I review and audits medical and/or dental claims to recover payments. They will provide day-to-day management of active overpayment recoveries. Specialist will work to maximize recovery amounts due to refund of payments made in error to members, providers, retro terms, and/or focused provider audits. This position will work closely with the claims, service, financial, and vendor auditing departments to complete claims adjustments.

Responsibilities

• Review and audit medical and/or dental claims to recover overpayments, ensuring all parts of the process are documented properly.
• Initiate recovery efforts for members and/or providers consistent with local and federal mandates.
• Distribute written correspondence to members and/or providers to recoup overpaid claims, negotiate repayment agreements when necessary, and ultimately reduce the company's care line.
• Communicate via phone, email, and correspondence with carriers, members and/or providers to recover and settle unpaid claims.
• Respond to carrier, member, provider, and/or customer service inquiries regarding outstanding claims and/or overpayment balances.
• Investigate and perform adjustments to claims to reflect cash returned by members and/or providers in order to reduce and accurately reconcile customer accounts.
• Participate in all internal/external meetings relating to Audit and Recoupment.
• Improve claims audit and recoupment job knowledge by attending training sessions.

Qualifications

• High School Diploma or GED
• 3 years claims processing
• Preferred: Claims adjustment experience

Skills

• Mathematical ability/aptitude
• Communication skills
• Ability to deal with both internal and external clients

Pay

Salary Range: $35,712 - $65,472. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location.

Benefits

In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).