Claims Recovery Examiner

Health Care Service Corporation; Oregon; Hybrid; USD 24,000 - 39,000; Full time

Job summary

Health Care Service Corporation is seeking a detail-oriented professional to research refund checks, out of balance entries, and non-negotiated checks, ensuring accurate application of complex pricing and contract terms. The role involves coordinating benefits and reimbursement methodologies and requires strong analytical and communication skills.

The ideal candidate will have at least 1 year COB experience, solid mathematical ability, and the capacity to handle changing priorities while

Qualifications

• High school diploma or GED.
• 1 year COB experience.
• Ability to determine health care reimbursement methodologies and coordinate benefits.
• Organizational and time management skills; flexibility with changing priorities.
• Teamwork and ability to work independently when needed.
• Strong mathematical skills.
• Strong problem solving and analytical skills.

Responsibilities

• Research refund checks, out of balance entries, and non-negotiated checks.
• Coordinate with benefits and payor contracts to determine reimbursement methods.
• Apportion work with attention to accuracy and timeliness.

Skills

COB coordination

Reimbursement methods

Verbal communication

Analytical skills

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

Must reside in New MexicoUnder 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.
• Must demonstrate excellent verbal communication skills, including the ability to confidently conduct outbound calls to obtain additional information, clarify details, and resolve issues. The candidate should communicate clearly, professionally, and effectively while maintaining positive relationships with customers and business partners.

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-CH1INKT

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 visitingThe 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.This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii.

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. We are a drug-free and smoke-free workplace. Employment may be contingent upon successful completion of drug screening in accordance with applicable law.

Base Pay Range

$17.75 - $28.39Exact compensation may vary based on skills, experience, and location.