Claims Recovery Examiner

Health Care Service Corporation•National, NV

4d•$18 - $28•Remote

About The Position

At HCSC, employees are described as the cornerstone of the business and the foundation of its success. The company offers curated development plans intended to foster growth and support rewarding careers. This position must reside in New Mexico. Under supervision, the Claims Recovery Examiner researches refund checks, out-of-balance entries, and non-negotiated checks. Research may lead to offsetting, voiding, or reissuing provider checks. The work requires knowledge of complex pricing, contract pricing, and coordination of benefits. The role requires strong verbal communication, including confidently making outbound calls to obtain information, clarify details, and resolve issues while maintaining positive relationships with customers and business partners. Qualified Indian candidates receive preference in filling vacancies in accordance with the Indian Preference Act of 1934 and other cited laws. The position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii; the posting also states that the employee must reside in New Mexico. Compensation is based on job-related skills, education, knowledge, and experience. The role aligns with an annual incentive bonus plan subject to its terms and conditions. The stated base pay range is $17.75–$28.39. HCSC describes its total rewards package as including health and wellness benefits, a 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, an employee assistance program, paid holidays, tuition reimbursement, and other incentives.

Requirements

High school graduate or GED.
One year of coordination of benefits (COB) experience.
Ability to determine health care reimbursement methodologies and coordinate benefits.
Organizational and time management skills, with flexibility in dealing with changing priorities.
Ability to work with others or independently as warranted by the task.
Strong mathematical skills.
Strong problem-solving and analytical skills.
Excellent verbal communication skills, including confidence conducting outbound calls to obtain information, clarify details, and resolve issues.
Must reside in New Mexico.

Nice To Haves

Two years of progressively responsible experience in IHS Department claims processing or Customer Service areas.
Two years of accounting experience or a good understanding of accounting practices, or two years of progressively responsible claims-processing experience that includes COB processing.

Responsibilities

Research refund checks, out-of-balance entries, and non-negotiated checks.
Take appropriate action based on research, including offsetting, voiding, or reissuing provider checks.
Apply knowledge of complex pricing, contract pricing, and coordination of benefits.
Make outbound calls to obtain additional information, clarify details, and resolve issues.
Communicate professionally and effectively with customers and business partners.