Insurance Settlement Recovery Specialist

Overview

Job Title: Insurance Settlement Recovery Specialist

Department: Revenue Cycle

Reports To: TDI / IDR Manager

FLSA Status: Non Exempt

The Insurance Settlement Recovery Specialist is responsible for post determination and post settlement follow up to ensure timely and accurate payment of Texas Department of Insurance (TDI) and Independent Dispute Resolution (IDR) claims. This role monitors payment timelines, identifies Texas Prompt Pay Act (TPPA) violations, and initiates recovery actions including payer follow up, reconsiderations, prompt pay letters, and complaints when necessary.

• Monitor IDR determinations to confirm payments are received within required time frames and follow up on unpaid determinations within statutory deadlines
• Review IDR settlements to validate payment accuracy and correct posting using settlement documentation and tracking reports
• Monitor TDI settlements and follow up on payments not received within required time frames
• Upload determination letters and supporting documentation into payer portals
• Initiate and manage reconsideration processes with insurance payors
• Conduct follow up calls regarding unpaid or incorrectly paid claims, settlements, and penalty payments
• Identify claims in violation of the Texas Prompt Pay Act
• Prepare, submit, and manage required forms and actions related to prompt pay violations, including pursuing penalty payments and filing complaints with noncompliant insurance companies
• Maintain detailed documentation for all accounts and correspondence to support tracking, audit readiness, and compliance
• Identify and communicate payer trends or recurring issues to management
• Maintain confidentiality of patient information in accordance with HIPAA guidelines
• Provide departmental and organizational support as needed
• Perform other duties as assigned

• High School Diploma or equivalent required
• Experience in medical billing, claims follow up, insurance recovery, TDI, or IDR preferred
• Knowledge of the Texas Prompt Pay Act preferred

• Ability to interpret EOBs, settlement documentation, and determination letters
• Knowledge of medical billing processes and third party payer requirements
• Familiarity with TDI, IDR, and payer portals preferred
• Experience using spreadsheets and tracking tools such as Excel or Smartsheets
• Strong organizational and documentation skills
• Proficiency with Microsoft Outlook, Word, Excel, and Teams
• Strong written and verbal communication skills
• Ability to work collaboratively with all levels of staff and management

Fast paced, high volume, and dynamic work environment requiring strong attention to detail and effective time management.