Specialist, Claims Recovery (Remote)

Our client operates within the healthcare managed care industry, focusing on claims processing and recovery. They address the challenge of ensuring accuracy and compliance in claim payments, working to recover overpayments made to healthcare providers. Through collaboration with health plans and vendors, the program manages claims recovery to maintain cost control and provider compliance.

About the role

The Specialist, Claims Recovery supports claims recovery activities by researching claim payments and billing guidelines to validate overpayments. This role ensures timely recovery of outstanding payments and maintains accurate documentation and reporting. The position contributes to reducing financial discrepancies and improving claims process efficiency.

Responsibilities

• Prepare written provider overpayment notifications with supporting documentation.
• Maintain and reconcile reports for outstanding payments, past-due overpayments, uncollectible claims, and autopayment recoveries.
• Prepare write-off documents for uncollectible claims after collection efforts.
• Research claims using federal guidelines and organizational policies to validate overpayments.
• Complete basic validation tasks prior to offset, including eligibility and coordination of benefits.
• Enter and update recovery applications and claim systems across multiple states.
• Follow processing policies for claims reversal, adjustments, and recovery documentation.
• Respond to provider correspondence related to claims recovery.
• Collaborate with finance to post provider and vendor refund checks accurately.
• Support initiatives to improve overall claims function efficiency.
• Meet departmental quality and production standards.
• Complete basic claims projects as assigned.

Requirements

• Minimum 1 year clerical experience in claims or customer service, preferably in managed care, or equivalent education and experience.
• Proficient in research and data entry.
• Strong organizational skills and attention to detail.
• Effective time-management to handle multiple projects and meet deadlines.
• Customer service experience.
• Effective verbal and written communication skills.
• Proficiency with Microsoft Office and applicable software.

Preferred Qualifications

• Experience in claims recovery.
• Health insurance experience within managed care.