Claims Recovery Analyst I - Payer

📋 Description

• Learn and apply client-specific claims adjudication systems, member and provider contracts, payment
• Support identification, validation, and recovery of healthcare claim overpayments.
• Review claims to verify recovery algorithm accuracy and refunds/adjustments processed.
• Investigate and resolve disputed overpayments with clients and providers while maintaining
• Research CMS, Medicaid, provider, member, and client policies to identify new overpayment
• Analyze medical and pharmacy claims, provider data, and enrollment data to identify patterns and

🎯 Requirements

• Experience identifying, analyzing, and recovering healthcare claim overpayments preferred.
• Bachelor’s degree in accounting, business, healthcare, or related field; equivalent work experience
• High school diploma or equivalent required.
• Strong computer skills and proficiency with Microsoft Excel.
• Analytical and problem-solving abilities; interpret complex claims and payment information.
• Excellent written, verbal, and interpersonal communication; build relationships with payers

🎁 Benefits

• Salary: $50,000–$60,000 USD per year.
• Remote work environment.
• Health insurance benefits.
• 401(k) plan with employer match.
• Paid parental leave.
• Collaborative and innovative work environment.