Claims Recovery Examiner

hcsc; Albuquerque (NM); Remote; USD 24,000 - 39,000; Full time

Job summary

HCSC is seeking a detail-oriented professional to research refund checks, out-of-balance entries and non-negotiated provider checks. The work may require offsetting, voiding or reissuing payments and demands knowledge of complex pricing, contract pricing and coordination of benefits.

Requirements include a high school diploma or GED, 1 year COB experience, ability to determine health care reimbursement methods, and strong math and analytical skills with good organizational and time-management

Qualifications

• High school diploma or GED required.
• 1 year COB experience.
• Ability to determine health care reimbursement methodologies.
• Strong math, analytical, and problem-solving skills.

Responsibilities

• Research refund checks, out-of-balance entries and non-negotiated provider checks.
• Assist with offsetting, voiding or reissuing payments as needed.

Skills

COB experience

Healthcare pricing knowledge

Coordination of benefits

Analytical skills

Mathematical skills

Time management

Teamwork

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.

Job Summary

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,

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Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

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.

Base Pay Range

$17.75 - $28.39

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