Claims Recovery Specialist I (Remote)

Summary

CareFirst BlueCross BlueShield is a healthcare insurance organization seeking a Claims Recovery Specialist I to review and audit medical and dental claims for overpayment recovery. The role manages active recoveries, communicates with members, providers, and carriers, adjusts claims, documents recovery activity, and participates in audit and recoupment meetings and training.

Responsibilities

• Under direct supervision, review and audits medical and/or dental claims to recover overpayments, ensuring all parts of the process are documented properly. Initiates recovery efforts for members and/or providers consistent with local and federal mandates. Distributes written correspondence to members and/or providers in order to recoup overpaid claims, negotiate repayment agreements when necessary, and ultimately reduce the companys care line
• Communicates, via phone, email, and correspondence, with carriers, members and/or providers to recover and settle unpaid claims. Responds to carrier, member, provider, and/or customer service inquiries regarding outstanding claims and/or overpayment balances. Investigates and performs Investigates and performs adjustments to claims to reflect cash returned by members and/or providers in order to reduce and accurately reconcile customer accounts
• Participate in all internal/external meetings relating to Audit and Recoupment. Improves claims audit and recoupment job knowledge by attending training sessions

Skills

• High School Diploma or GED
• 3 years claims processing
• Mathematical ability/aptitude
• Communication skills
• Ability to deal with both internal and external clients
• The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted
• Must be eligible to work in the U.S. without Sponsorship
• Claims adjustment experience

Qualifications

Must Haves

• High School Diploma or GED
• 3 years claims processing
• Mathematical ability/aptitude
• Communication skills
• Ability to deal with both internal and external clients
• The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted
• Must be eligible to work in the U.S. without Sponsorship

Nice to Haves

• Claims adjustment experience

Benefits

• Remote work arrangement
• CareFirst offers a comprehensive benefits package
• Various incentive programs/plans, subject to eligibility requirements
• 401k contribution programs/plans, subject to eligibility requirements