Claims Recovery Specialist I (Remote)

CareFirst•Baltimore, MD

2d•Remote

About The Position

Under direct supervision, the Claims Recovery Specialist I reviews and audits medical and/or dental claims to recover payments. They will provide day-to-day management of active overpayment 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.

Requirements

High School Diploma or GED.
3 years claims processing.
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.
Must be eligible to work in the U.S. without Sponsorship

Nice To Haves

Claims adjustment experience.

Responsibilities

Under direct supervision, review and audits medical and/or dental claims to recover overpayments, ensuring all parts of the process are 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 overpayment balances.
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.