Specialist, Claims Recovery (Remote)

JOB DESCRIPTION Job Summary Provides support for claims recovery activities including researching claim payment and billing guidelines, audit results, and federal regulations to determine overpayment accuracy and provider compliance. Collaborates with health plans and vendors to facilitate recovery of outstanding overpayments. Monitors and controls backlog and workflow of claims and ensures that claims are settled in a timely fashion and in accordance with cost-control standards. Essential Job Duties • Prepares written provider overpayment notifications and provides supporting documentation such as explanation of benefits (EOBs), claims and attachments. • Maintains and reconciles department reports for outstanding payments collected, past-due overpayments, uncollectible claims and autopayment recoveries. • Prepares and provides write-off documents that are deemed uncollectible, and ensures collections efforts are exhausted for write-off approval. • Researches simple to com...