Claims Recovery Specialist ; Remote

Resp & Qualifications

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 over payment 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.

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 over payment 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.

• Under direct supervision, review and audits medical and/or dental claims to recover over payments, ensuring all parts of the process is documented properly. Initiates recovery efforts for members and/or providers consistent with local and federal mandates. Distributes written correspondence to members and/or providers in order to recoup overpaid claims, negotiate repayment agreements when necessary, and ultimately reduce the company's care line.
• Communicates, via phone, email, and correspondence, with carriers, members and/or providers to recover and settle unpaid claims. Responds to carrier, member, provider, and/or customer service inquiries regarding outstanding claims and/or over payment balances. Investigates and performs Investigates and performs 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. Improves claims audit and recoupment job knowledge by attending training sessions.

Education Level: High School Diploma or GED.

Experience: 3 years claims processing.

• Claims adjustment experience.

• Mathematical ability/aptitude.
• Communication skills.
• Ability to deal with both internal and external clients.
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

$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.

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

Care First Blue Cross Blue Shield is an Equal…