Claims Recovery Analyst I – Payer

This is a fully remote position, open to applicants in United States.

📋 Description

• Gain expertise in clients’ claims adjudication systems, as well as member and provider contracts, along with claim payment policies and procedures.

• Support clients in identifying, validating, and recovering overpayments on claims.

• Validate claims to ensure algorithm accuracy and verify that no prior refunds have been processed.

• Review and resolve disputes regarding overpayments from clients or providers.

• Engage in knowledge sharing to address claim issues and seek necessary clarifications.

• Recognize overpayment opportunities and trends by researching CMS and Medicaid policies, client systems, vendor adjustments, and contracts.

• Interpret and analyze medical and pharmacy claims data, provider data, and enrollment information.

• Assist Management by providing concept approval details for client authorization.

• Develop step-by-step instructions for algorithms transitioned to production.

• Represent Trend and its clients in a professional manner.

• Collaborate effectively with team members to achieve goals and complete tasks in a timely manner.

• Offer feedback to Management regarding inventory levels, algorithm effectiveness, productivity, and new suggestions.

• Work with Management to identify opportunities for improvement and innovative solutions.

• Escalate issues that might negatively affect business relationships.

• Provide training and support to new analysts as required.

• Perform additional duties as assigned.

• Fulfill necessary compliance requirements, which may include background checks, drug screenings, and the disclosure of personal health or identifiable information.

⛳️ Requirements

• Proven experience in identifying, analyzing, and recovering overpayments on claims.

• Bachelor’s degree in accounting, business, healthcare, or a related field.

• Relevant work experience in a similar role may be accepted as a substitute for educational qualifications.

• Proficient computer skills, particularly in Excel.

• Excellent communication and interpersonal abilities.

• Strong analytical and problem-solving capabilities.

• Effective organizational and time management skills.

• Ability to learn, understand, and implement new technologies.

• High School Diploma or Equivalent is required.

• Experience in medical claims processing is preferred.

• Familiarity with creating and maintaining complex queries is preferred.

🏝️ Benefits

• Competitive salaries.

• Health insurance coverage.

• 401(k) plan with employer matching contributions.

• Paid parental leave.