Senior Claims Analyst - Overpayments & Recovery

Trend Health Partners, Inc.; United States; Remote; USD 70,000 - 80,000; Full time

Benefits offered by this job

Health insurance

401(k) with employer match

Paid parental leave

Job summary

TREND Health Partners is a tech-enabled payment integrity company seeking a Claims Analyst III to identify and recover claim overpayments for commercial payers and state programs. You will analyze claims, systems, and documents to develop concepts that identify overpayments and ensure timely, accurate processing.

The role emphasizes rigorous data analysis, collaboration with clients, and adherence to policies.

Qualifications

• Bachelor’s degree in accounting, business, healthcare, or a related field
• Equivalent work experience may substitute for education
• Experience in identification, auditing, and recovery of claim overpayments
• Strong understanding of calculations and medical terminology
• Excellent computer skills and proficient in Excel
• Strong analytical and problem-solving skills
• Strong communication and interpersonal skills with providers, management, and peers

Responsibilities

• Assist client in identifying, validating, and recovering claim overpayments.
• Validate claims to ensure accuracy of algorithms and that no refund has previously been posted to the client’s system(s).
• Review and resolve disputed overpayments from client/provider.
• Participate in knowledge sharing to brainstorm and resolve claim issues or seek clarifications.
• Identify new overpayment opportunities and trends by reviewing CMS/Medicaid policies, client processes, and contracts.
• Interpret and analyze medical and pharmacy claims data to assess trends and opportunities.
• Assist Management with concept approval information needed for client approvals on specific trends.
• Complete step-by-step instructions for each algorithm moved to production.
• Represent TREND and our clients professionally.
• Collaborate with TREND Management to identify opportunities and improvements.
• Escalate issues outside control to the manager.
• Train and assist new analysts while maintaining quality and production results.
• Assist with Quality Review process.
• Ensure staff resolves daily problems timely and effectively.

Skills

Claim overpayments

Data analysis

Excel proficiency

Problem-solving

Communication skills

Regulatory knowledge

Education

Bachelor's degree in accounting/business/healthcare

Tools

Excel

Job description

TREND Health Partners is a tech-enabled payment integrity company seeking a Claims Analyst III to identify and recover claim overpayments for commercial payers and state programs. You will analyze claims, systems, and documents to develop concepts that identify overpayments and ensure timely, accurate processing.

The role emphasizes rigorous data analysis, collaboration with clients, and adherence to policies.