Claims Recovery Specialist I - Overpayment Audits Recoveries

CareFirst BlueCross BlueShield; Baltimore (MD); On-site; USD 36,000 - 65,000; Full time

Job summary

CareFirst BlueCross BlueShield is seeking a Claims Recovery Specialist I to review and audit medical and/or dental claims to recover overpayments. Under direct supervision, you will manage daily recoveries and coordinate with claims, service, financial, and vendor auditing teams to complete adjustments.

The role requires a High School Diploma or GED and 3 years of claims processing experience, with a preference for claims adjustment expertise.

Qualifications

• Education: High School Diploma or GED.
• Experience: 3 years claims processing.
• Preferred: claims adjustment experience.

Responsibilities

• Review and audit medical/dental claims to recover overpayments under supervision.
• Communicate with carriers, members and providers to recover and settle unpaid claims.
• Participate in internal/external meetings related to Audit and Recoupment; attend training to improve knowledge.

Skills

Communication skills

Customer service

Time management

Interpersonal skills

Attention to detail

Job description

CareFirst BlueCross BlueShield is seeking a Claims Recovery Specialist I to review and audit medical and/or dental claims to recover overpayments. Under direct supervision, you will manage daily recoveries and coordinate with claims, service, financial, and vendor auditing teams to complete adjustments.

The role requires a High School Diploma or GED and 3 years of claims processing experience, with a preference for claims adjustment expertise.