Overpayment Recovery Specialist — Claims

Molina Healthcare; Spokane (WA); On-site; USD 30,000 - 46,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare in Spokane, WA seeks a Claims Recovery Specialist responsible for researching claim payments, validating overpayments, and coordinating with plans and vendors to recover funds. The role emphasizes accuracy, timely action, and compliance with cost-control standards.

The position requires at least 1 year in a clerical claims or customer service setting, strong data entry and communication skills, and proficiency with Microsoft Office.

Qualifications

• At least 1 year in a clerical claims or customer service role.
• Research and data entry skills are required.
• Strong organization and time-management abilities.
• Effective verbal and written communication skills.
• Proficiency with Microsoft Office and related software.

Responsibilities

• Prepare written provider overpayment notifications with supporting docs.
• Maintain and reconcile reports for outstanding payments and recoveries.
• Prepare write-off documents for uncollectible claims and pursue exhaust of collections.
• Research simple to complex claims using guidelines to validate overpayments.
• Validate eligibility, COB, SOC, and DRG before offset.
• Enter/update recovery applications and process refunds or auto debit.
• Follow SOPs for processing policies and documentation.
• Respond to provider inquiries related to recovery and remittances.
• Collaborate with finance to post refund checks and requests.
• Support claims efficiency initiatives and meet quality standards.
• Complete basic claims projects as assigned.

Skills

Research and data entry

Organizational skills

Time-management

Customer service

Verbal and written communication

Tools

Microsoft Office suite

Job description

Molina Healthcare in Spokane, WA seeks a Claims Recovery Specialist responsible for researching claim payments, validating overpayments, and coordinating with plans and vendors to recover funds. The role emphasizes accuracy, timely action, and compliance with cost-control standards.

The position requires at least 1 year in a clerical claims or customer service setting, strong data entry and communication skills, and proficiency with Microsoft Office.