Healthcare Reclamation Analyst

About Our Client

The organization operates in the healthcare intelligence industry, focusing on improving financial outcomes and reducing costs for health plans. It serves over 85 health plans across the country, including many of the top 20, representing more than 270 million lives. The company provides an AI-powered platform combined with expertise to enhance transparency and efficiency across the payment continuum.

About the Opportunity

The Healthcare Reclamation Analyst is responsible for reviewing client data and payer correspondence to investigate coverage eligibility and primacy. This role aims to recover funds paid in error by clients, ensuring accurate coordination of benefits. The position plays a critical part in resolving discrepancies and facilitating correct payment processes for health plan clients.

Responsibilities

• Review client data alongside payer correspondence to determine order of benefits and resolve primacy issues.
• Investigate and analyze explanation of benefits (EOBs) and payer feedback to support fund recovery.
• Communicate effectively with carriers to clarify coverage and coordinate benefits.
• Educate insurance carriers on Coordination of Benefits rules and respond to complex queries.
• Support internal teams with claims billing and denial management.
• Follow and contribute to improvement of communication scripts and guidelines.
• Manage assigned inventories to meet productivity metrics.
• Research eligibility and claims appeals to achieve successful resolution and payment.
• Update systems with accurate account information and contact details.
• Comply with relevant policies, procedures, HIPAA, and regulatory requirements.
• Complete required training and maintain client clearances as a condition of employment.
• Achieve or exceed established production and quality goals.
• Address corrective actions from quality reviews or management.
• Work overtime as necessary and perform other duties as assigned.

Requirements

• Minimum 2 years of progressive experience in billing reclamation or a related role.
• At least 12 months of collections or receivables experience with consistent high production.
• Strong research and analytical skills.
• High school diploma or GED; relevant college courses or certifications are a plus.
• Solid knowledge of healthcare, medical terminology, coding, and experience in auditing or recovery.
• Experience with Coordination of Benefits, Third Party Liability, and Accounts Receivable.
• Ability to interpret EOBs and resolve payment issues.
• Professional communication skills for interacting with providers and carriers.
• Understanding of HIPAA standards and patient privacy.
• Strong interpersonal skills with a customer service orientation.
• Self-motivated with attention to detail and ability to manage multiple tasks.
• Proficiency with standard office technology and software.