Overpayment Recovery Specialist

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

Job summary

CareFirst BlueCross BlueShield seeks a Claims Recovery Specialist I to review and audit medical and dental claims, manage active overpayments, and maximize recovery amounts. The role collaborates with claims, service, financial, and vendor auditing teams to complete adjustments and ensure compliance with applicable mandates.

Under supervision, you will communicate with members, providers, and carriers to recover balances, negotiate repayment terms when necessary, and support overall refunds and

Qualifications

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

Responsibilities

• Review and audit medical and/or dental claims to recover overpayments, ensuring proper documentation. Initiates recovery efforts for members/providers. Includes negotiating repayment when needed.
• Communicates with carriers, members, and providers to recover and settle unpaid claims and respond to inquiries about overpayment balances.
• Participate in internal/external audit and recoupment meetings and pursue ongoing knowledge through training.

Skills

Math aptitude

Communication

Client interaction

Deadline oriented

Education

High School Diploma or GED

Job description

CareFirst BlueCross BlueShield seeks a Claims Recovery Specialist I to review and audit medical and dental claims, manage active overpayments, and maximize recovery amounts. The role collaborates with claims, service, financial, and vendor auditing teams to complete adjustments and ensure compliance with applicable mandates.

Under supervision, you will communicate with members, providers, and carriers to recover balances, negotiate repayment terms when necessary, and support overall refunds and