Remote Claims Recovery Specialist I (Overpayments)

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

Job summary

CareFirst BlueCross BlueShield is seeking a Claims Recovery Specialist I to manage the recovery of overpayments on medical and dental claims under direct supervision. The role collaborates with claims, service, finance, and vendor audit teams to ensure accurate adjustments and timely recoveries.

Responsibilities include coordinating written communications with members and providers, negotiating repayment agreements when needed, and supporting continuous improvement through audits and training.

Qualifications

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

Responsibilities

• Review and audit medical and dental claims to recover overpayments and manage active recoveries.
• Communicate with carriers, members, and providers to recover and settle unpaid claims.
• Participate in audits and trainings to improve audit and recoupment processes.

Skills

Mathematical ability

Communication skills

Client management

Education

High School Diploma or GED

Job description

CareFirst BlueCross BlueShield is seeking a Claims Recovery Specialist I to manage the recovery of overpayments on medical and dental claims under direct supervision. The role collaborates with claims, service, finance, and vendor audit teams to ensure accurate adjustments and timely recoveries.

Responsibilities include coordinating written communications with members and providers, negotiating repayment agreements when needed, and supporting continuous improvement through audits and training.