Claims Recovery Specialist I (Remote)

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 manage the recovery of overpayments on medical and dental claims under direct supervision. The role collaborates with claims, service, finance, and vendor audit teams to ensure accurate adjustments and timely recoveries.

Responsibilities include coordinating written communications with members and providers, negotiating repayment agreements when needed, and supporting continuous improvement through audits and training.

Qualifications

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

Responsibilities

• Review and audit medical and dental claims to recover overpayments and manage active recoveries.
• Communicate with carriers, members, and providers to recover and settle unpaid claims.
• Participate in audits and trainings to improve audit and recoupment processes.

Skills

Mathematical ability

Communication skills

Client management

Education

High School Diploma or GED

Job description

Resp & Qualifications

Under direct supervision, the Claims Recovery Specialist I review and audits medical and/or dental claims to recover payments. They will provide day-to-day management of active overpayment recoveries. Specialist will work to maximize recovery amounts due to refund of payments made in error to members, providers, retro terms, and/or focused provider audits. This position will work closely with the claims, service, financial, and vendor auditing departments to complete claims adjustments.

Purpose

Under direct supervision, the Claims Recovery Specialist I review and audits medical and/or dental claims to recover payments. They will provide day-to-day management of active overpayment recoveries. Specialist will work to maximize recovery amounts due to refund of payments made in error to members, providers, retro terms, and/or focused provider audits. This position will work closely with the claims, service, financial, and vendor auditing departments to complete claims adjustments.

Essential Functions

• Under direct supervision, review and audits medical and/or dental claims to recover overpayments, ensuring all parts of the process are documented properly. Initiates recovery efforts for members and/or providers consistent with local and federal mandates. Distributes written correspondence to members and/or providers in order to recoup overpaid claims, negotiate repayment agreements when necessary, and ultimately reduce the companys care line.
• Communicates, via phone, email, and correspondence, with carriers, members and/or providers to recover and settle unpaid claims. Responds to carrier, member, provider, and/or customer service inquiries regarding outstanding claims and/or overpayment balances. Investigates and performs Investigates and performs adjustments to claims to reflect cash returned by members and/or providers in order to reduce and accurately reconcile customer accounts.
• Participate in all internal/external meetings relating to Audit and Recoupment. Improves claims audit and recoupment job knowledge by attending training sessions.

Qualifications

Education Level:

High School Diploma or GED.

Experience:

3 years claims processing.

Preferred Qualifications

Claims adjustment experience.

Knowledge, Skills And Abilities (KSAs)

• Mathematical ability/aptitude.
• Communication skills.
• Ability to deal with both internal and external clients.

Salary Range: $35,712 - $65,472

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location.

In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

Facets Coordination of Benefit

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

Physical Demands

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship.