Claims Recovery Examiner

hcsc; United States; A distancia; USD 25.000 - 39.000; Jornada completa

Descripción de la vacante

Health Care Service Corporation is seeking a detail‑oriented specialist to research refund checks, out‑of‑balance entries, and non‑negotiated checks. The role involves complex pricing and coordination of benefits, with a focus on accurate reimbursement methodologies and provider communications.

The candidate should have COB experience, strong math and analytical skills, and the ability to manage shifting priorities while delivering clear, professional support to customers.

Formación

• Knowledge of COB workflows and coordination of benefits.
• Strong mathematical, analytical and problem solving skills.
• Organizational and time management skills; flexible with changing priorities.
• Ability to communicate clearly and professionally with customers and partners.
• Team-oriented with capacity to work independently as needed.

Responsabilidades

• Research refund checks, out-of-balance entries and non-negotiated checks.
• Determine health care reimbursement methodologies and coordinate benefits.
• Coordinate with providers and internal teams to resolve issues and inquiries.

Descripción del empleo

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.

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,

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.

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 .

Base Pay Range

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