Claims Recovery Examiner

Customer Service; Albuquerque (NM); On-site; USD 24,000 - 39,000; Full time

Job summary

HCSC is seeking a detail-oriented specialist to research refund checks, out-of-balance entries, and non-negotiated provider checks under supervision. The role requires understanding of complex pricing, contract pricing, and coordination of benefits to ensure accurate reimbursements.

Ideal candidates have strong math, analytical skills, and the ability to handle changing priorities. COB experience is preferred; 2-3 years in health care claims or customer service is a plus.

Qualifications

• Strong mathematical skills and numerical accuracy.
• Ability to identify and resolve discrepancies in COB and provider payments.
• Excellent organizational and time management skills; able to adapt to changing priorities.
• Team-oriented with the ability to work independently when needed.

Responsibilities

• Research refunds, out of balance entries, and non-negotiated checks.
• Potential actions include offsetting, voiding, or reissuing provider checks.
• Work with complex pricing, contract pricing, and coordination of benefits.

Skills

Analytical skills

Problem solving

Mathematical skills

Time management

Teamwork

Adaptability

COB knowledge

Education

High school diploma or GED

Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Under supervision, this position is responsible for researching refund checks, out of balance entries and non-negotiated checks. The research may result in action including offsetting, voiding or reissuing provider checks. The processes require knowledge of complex pricing, contract pricing and coordination of benefits.

Job Requirements

• High school graduate or GED.
• 1 year experience of coordination of benefits (COB) experience
• Ability to determine health care reimbursement methodologies and coordinate benefits.
• Organizational and time management skills; flexibility in dealing with changing priorities.
• Team skills, including the ability to work with other or work independently as warranted by the task.
• Strong mathematical skills.
• Strong problem solving and analytical skills.

Preferred Job Requirements

• 2 years progressive responsibility in IHS Department claims processing or Customer Service areas.
• 2 years of accounting experience or good understanding of accounting practices or 2 years of progressive responsibility in claims processing to include COB processing.

Preference in filling vacancies is given to qualified Indian candidates in accordance with the Indian Preference Act of 1934 (title 25, USC Section 472) Native American Indian Preference shall apply to this position pursuant to the Indian Self-Determination and Education Assistance Act (24 U.S.C. 450, et seq.), 25 CFR 271.44 and other relevant laws (title 25, #LI-Remote #LI-CH1 INJLF

Compensation: $17.75 - $28.39

Exact compensation may vary based on skills, experience, and location

HCSC Employment Statement

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.