Claims - Recovery Specialist, Claims

Wellcove•PENSACOLA, FL

6d•Hybrid

About The Position

Claims Recovery Specialist is responsible for providing clerical support to review, research and systematically post claim refunds, voids, offsets, and payment reissues. Provide clerical support on all other essential paperwork that supports overpayment recovery for the Claim Department. This position will work in the Pensacola office twice a week every other week or as needed.

Responsibilities

Accurately post refunds to claims system
Accurately apply overpayment recoveries to offset status
Send Refund requests letters as overpayments are identified
Provide clerical support for letters, collection and correspondence relating to subrogation cases and subpoenas.
Research all incoming returned checks i.e., voids and checks returned via mail
Accurately void and reissue claim payments as required.
Work on Vendor system to make sure all payments voided by Vendor are voided in our Claim System.
Telephone follow up calls to Providers regarding status of refund requests.
Review identified claims on weekly reports to determine if refund request(s) is appropriate
Communicate refund overpayment information to providers and vendor via phone, email and/or letter
Determine reasons for refunds, source of refunds, and update accordingly on the claims system
Assist in documenting identified trends in refunds and voids received by type, provider, or examiner and report findings to Management.
Responsible for logging outstanding check clearances for Finance review
Provide Clerical Support for Provider Address, W-9, and 1099 updates/changes
Responsible for working with check vendor on check voids and reissues
Ability to Provide Assigned Onsite Office Mail Center Support for Claim Department
Other Claim Department duties as assigned
Must maintain current knowledge of federal, state, and local insurance regulations and requirements.
Must maintain working knowledge of assigned company and services pertaining to business segment.
Must Maintain working knowledge and proficiency in company systems and Microsoft applications.
Operates within company regulations regarding HIPAA, fraud, confidentiality, and private health information.