Cost Containment Analyst – HMO Claims

CommunityCare, Inc.; Tulsa, Northern (OK, KY); Hybrid; USD 40,000 - 60,000; Full time

Job summary

CommunityCare, Inc. in Tulsa, OK, is seeking a Cost Containment Specialist to help ensure accurate reimbursement on claims and manage overpayments across multiple lines of business.

This role emphasizes analytics, COB coordination, and effective communication with providers and internal teams. The ideal candidate has strong claims processing knowledge, attention to detail, and proficiency with Microsoft Office.

Qualifications

• Requires understanding of claims processing procedures and CPT codes.
• Experience with provider communications and collections is preferred.
• Demonstrated accuracy in calculations and data entry.

Responsibilities

• Generate and update database of claims with refunds due.
• Run daily reports for future provider payable amounts by line of business.
• Recoup the proper dollar amount and track negative balances.
• Communicate with providers regarding outstanding overpayments.
• Reply to calls and emails promptly; update recoupment workflow.
• Generate reports of recouped dollars by line of business.
• Monitor and report reinsurance and COB status to stakeholders.
• Ensure correct application of coordination of benefits.

Skills

Claims processing

Microsoft Office

Attention to detail

Communication skills

Math/calculation

Education

High school diploma or equivalent

Tools

Microsoft Office Suite

Job description

CommunityCare, Inc. in Tulsa, OK, is seeking a Cost Containment Specialist to help ensure accurate reimbursement on claims and manage overpayments across multiple lines of business.

This role emphasizes analytics, COB coordination, and effective communication with providers and internal teams. The ideal candidate has strong claims processing knowledge, attention to detail, and proficiency with Microsoft Office.