Claims Recovery Specialist II

Job Summary

Working remotely on a full-time basis, the Claims Recovery Specialist II will review and audit medical and dental claims to recover overpayments, manage active recovery efforts, and collaborate with various departments to ensure accurate claims adjustments.

Key responsibilities

• Review, audit, and initiate recovery efforts for overpaid medical and dental claims, ensuring proper documentation
• Contact carriers, members, and providers to recover overpayments and respond to inquiries regarding outstanding claims
• Distribute written correspondence to policyholders to negotiate repayment agreements and educate vendors on claims procedures

Required qualifications

• High School Diploma or GED
• 5 years of experience in claims processing
• 1 year of experience in adjustment processing preferred
• Strong mathematical aptitude
• Ability to meet deadlines and handle multiple customer service demands