Claims Recovery Specialist

Job Summary

Providing senior-level support for claims recovery activities, the full-time remote Senior Specialist, Claims Recovery will research claim payment guidelines, collaborate with health plans to recover overpayments, and ensure timely claims processing in accordance with cost-control standards.

Key responsibilities

• Prepare written provider overpayment notifications and supporting documentation
• Maintain and reconcile department reports for outstanding payments and uncollectible claims
• Research claims payments and validate overpayments using various guidelines and policies

Required qualifications

• At least 3 years of experience in a clerical role in claims or customer service, with 1 year in claims recovery in a Medicaid managed care organization
• Working knowledge of claims payments and multiple state billing guidelines
• Strong research, analysis, and data entry skills
• Organizational and time-management skills to manage multiple projects
• Proficiency in Microsoft Office suite and applicable software programs