Recovery Analyst

Centivo • Buffalo, NY

14d • Hybrid

About The Position

We exist for workers and their employers -- who are the backbone of our economy. That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills.
The Recovery Analyst is primarily responsible for managing all file requirements from beginning to end for subrogation cases, No Surprises Act (NSA) disputes, and overpayment recoveries with the assigned third-party vendor. This includes researching paid claims, answering inquiries, coordinating with other departments, and adjusting claims based on overpayments of claims and settlements for both the subrogation and NSA processes. This individual will work as an effective interface between internal and external customers and maintain good member and partner relationships.

Requirements

• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others.
• Must possess proven organizational, rational reasoning, ability to examine information, and problem-solving skills, with attention to detail necessary to act within complex environment.
• Knowledge of applicable rules and statutes, of the process and principles of insurance and of basic subrogation and NSA concepts.
• Ability to comprehend and produce grammatically accurate, error-free business correspondence required.
• Ability to appropriately identify urgent situations and follow the appropriate protocol.
• Requires the ability to plan, manage multiple priorities, and deliver complete, accurate, and timely results in a fast-paced office environment.
• High School diploma or equivalent required, Associate degree preferred.
• At least one year of experience in health plan operations, claims processing, or other experience directly related to position duties and knowledge.
• At least one year of experience in NSA requests and subrogation.
• Additional years of experience/training may be considered in lieu of educational requirements required.

Responsibilities

• Prepare documentation, review claim history, and other documentation related to overpayment, subrogation, and NSA requests.
• Utilize available resources to investigate claim situations for overpayment, subrogation, and NSA cases.
• Follow-up with responsible departments and delegated entities to ensure compliance.
• Monitors daily and weekly inventory to ensure internal and regulatory timeframes are met.
• Identify areas of potential improvement and provide feedback and recommendations to management on issue resolution, quality improvement, network contracting, policies and procedures, administrative costs, cost-saving opportunities, best practices, and performance issues.
• Notifies the assigned vendors and clients of the subrogation and recovery interest; confers with other parties, internal departments, and clients concerning potential settlement or other actions.
• Represents Centivo in meetings concerning recovery, subrogation, and NSA matters, including facilitating calls between Centivo’s third-party vendor and the client, to obtain final approval.
• Maintain data entry requirements for all complaints and appeals.
• Perform any other additional tasks or duties as assigned or required.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED