Senior Claims Recovery & Overpayments Analyst

EmblemHealth; New York (NY); On-site; USD 56,000 - 99,000; Full time

Job summary

EmblemHealth, a leading not-for-profit health insurer in New York, seeks an experienced Senior Claims Overpayment & Recovery Analyst to drive financial recovery and improve payment accuracy. Your role will involve auditing, data analysis, and collaboration with providers and internal teams to identify overpayments and implement corrective actions.

You will analyze complex claims and support leadership with actionable insights.

Qualifications

• Bachelor's degree required; additional years of experience may be considered in lieu of education.
• 3–5+ years of relevant experience in auditing and financial recovery in a healthcare provider environment.
• Experience with Medicare Secondary Payer (MSP), Coordination of Benefits (COB), provider and member recoveries, and overpayment investigations.
• Experience interpreting CMS regulations, provider contracts, reimbursement methodologies, and health plan benefits.
• Ability to independently perform research using multiple sources; strong analytical skills.
• Pharmacy experience is preferred and beneficial.

Responsibilities

• Proactively assess and monitor vendor performance to meet contractual targets and quality expectations.
• Monitor and support daily financial recovery activities to ensure timely recovery of overpayments.
• Engage with Special Handling and other facilities/providers across the enterprise.
• Identify improvement opportunities and develop action plans to resolve issues and prevent recurrence.
• Strengthen claims recovery by partnering with provider networks and internal teams.
• Analyze recovery data and trends to recommend operational and policy improvements.
• Collaborate with IT to maximize system offset capabilities and expedite recoveries.
• Investigate potential third-party liability cases and prepare reports for leadership.

Skills

Auditing

Financial recovery

CMS regulations

Claim investigations

Data analysis

Root cause analysis

Education

Bachelor's degree

Job description

EmblemHealth, a leading not-for-profit health insurer in New York, seeks an experienced Senior Claims Overpayment & Recovery Analyst to drive financial recovery and improve payment accuracy. Your role will involve auditing, data analysis, and collaboration with providers and internal teams to identify overpayments and implement corrective actions.

You will analyze complex claims and support leadership with actionable insights.