Remote Payment Integrity & Claims Recovery Analyst

CareOregon; Washington; On-site; USD 91,886,000 - 112,274,000; Full time

Benefits offered by this job

Bonus opportunity

Medical insurance

Dental insurance

Vision insurance

Retirement plan

Job summary

CareOregon is seeking a Payment Integrity Analyst to execute claims investigation and recovery strategies. This role analyzes claims data to identify cost containment opportunities and conducts audits, coordinating with Clinical, Contracting, Finance, and Claims teams to ensure alignment.

The position emphasizes timely, accurate analyses and strong collaboration across departments. Ideal candidates leverage Medicare/Medicaid experience, advanced analytics, and proficient use of claims systems.

Qualifications

• Solid understanding of complex claims processing and payment integrity concepts.
• Knowledge of Medicare/Medicaid claims and payment methodologies.
• Strong analytical and problem-solving abilities.
• Excellent written and verbal communication skills.

Responsibilities

• Implement new payment integrity initiatives as directed by leadership.
• Review CMS/RAC topics for viability of paid claims.
• Audit and identify root causes of overpayments with remediation plans.
• Enter and update recovery information in claims systems and tools.
• Communicate effectively with internal and external stakeholders about recoveries.

Skills

Analytical skills

Claims processing

Communication

Time management

Tools

SQL Server Reporting

Tableau

Job description

CareOregon is seeking a Payment Integrity Analyst to execute claims investigation and recovery strategies. This role analyzes claims data to identify cost containment opportunities and conducts audits, coordinating with Clinical, Contracting, Finance, and Claims teams to ensure alignment.

The position emphasizes timely, accurate analyses and strong collaboration across departments. Ideal candidates leverage Medicare/Medicaid experience, advanced analytics, and proficient use of claims systems.