Remote Claims Recovery Specialist

All Care To You; California; A distancia; USD 55.000 - 75.000; Jornada completa

Descripción de la vacante

All Care To You, a fully remote MSO serving health plans and providers, seeks a Claims Recovery Examiner. You will review, request, and document claim refunds using Access, Excel, Word, Ez Cap, and related medical claims data.

The role requires attention to detail and strong collaboration with finance, IT, and provider networks. The position emphasizes compliance with claims processing rules, timely audits, and producing accurate refund reports.

Formación

• Five years’ experience processing Commercial, Medi-Cal and/or Medicare or other government agency claims.
• Proficient with medical terminology and coding.
• Strong knowledge of claims processing rules and turnaround times.
• Ez-Cap Experience preferred.
• Excellent written and verbal communication; highly organized.

Responsabilidades

• Review incoming recovery checks and close paid recoveries; contact providers with outstanding recoveries.
• Process and post daily refund checks; support reconciliation with Finance.
• Prepare weekly/monthly reports to management on refunds and reconciliations.
• Coordinate with multiple departments to obtain and verify claim refund information.
• Investigate and follow up on overpayments and claims issues; document findings.

Conocimientos

Detail oriented

Communication skills

Time management

Multi-tasking

Problem-solving

Herramientas

Ez-Cap

Outlook

Microsoft Teams

Zoom

Microsoft Word

Microsoft Excel

Adobe

Descripción del empleo

All Care To You, a fully remote MSO serving health plans and providers, seeks a Claims Recovery Examiner. You will review, request, and document claim refunds using Access, Excel, Word, Ez Cap, and related medical claims data.

The role requires attention to detail and strong collaboration with finance, IT, and provider networks. The position emphasizes compliance with claims processing rules, timely audits, and producing accurate refund reports.