Claims Recovery Specialist I (Remote)

CareFirst BlueCross BlueShield; United States; Remote; 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 dental claims to recover overpayments and manage active recoveries. You will work with claims, service, and finance teams to adjust claims and document processes.

Under supervision, you will communicate with members, providers and carriers by phone and email to negotiate repayment plans and finalize adjustments, while following federal and local mandates.

Qualifications

• High School Diploma or GED.
• 3 years claims processing experience.
• Preferred: claims adjustment experience.
• KSAs: math aptitude, strong communication, ability to work with internal and external clients.

Responsibilities

• Review and audit medical and dental claims to recover overpayments and manage recoveries.
• Distribute notices and negotiate repayment plans while ensuring compliance with mandates.
• Communicate with members, providers and carriers by phone/email to recover and settle unpaid claims.
• Assist in meetings related to audit and recoupment and pursue process improvements.

Skills

Math Aptitude

Communication

Client Relations

Education

High School Diploma or GED

Job description

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

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).