Claims Recovery Analyst I - Payer

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

📋 Description

• Gain a thorough understanding of clients' claims adjudication systems, member and provider contracts, as well as claim payment policies and procedures.

• Support clients in discovering, verifying, and recovering claim overpayments.

• Validate claims for algorithm accuracy and ensure that no refunds have been previously processed.

• Analyze and resolve disputed overpayments from clients and providers.

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

• Identify overpayment trends and opportunities by examining CMS and Medicaid claims processing policies, client adjustments, claims systems, and provider/member contracts.

• Interpret and evaluate medical and pharmacy claims, provider, and enrollment data to uncover trends and prospects.

• Assist Management with information for concept approval needed for client endorsement.

• Provide detailed step-by-step instructions for algorithms transitioned to production.

• Represent Trend and its clients in a professional manner.

• Collaborate with team members to achieve objectives and complete tasks effectively.

• Offer Management insights on inventory levels, algorithm performance/productivity, and new trends or ideas.

• Work with Management to pinpoint opportunities, enhancements, and innovative solutions.

• Escalate any situations that may negatively affect business relationships.

• Train and support new analysts while upholding quality and production standards.

• Perform additional duties as assigned.

⛳️ Requirements

• Proven experience in identifying, analyzing, and recovering claim overpayments.

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

• Equivalent professional experience in a similar role may substitute for educational qualifications.

• High School Diploma or Equivalent is required.

• Proficient computer skills and expertise in Excel.

• Excellent communication and interpersonal abilities.

• Strong analytical and problem-solving capabilities.

• Effective organizational and time management skills.

• Ability to learn and apply new technologies effectively.

• Preferably experienced in medical claims processing.

• Experience in creating and maintaining complex queries is a plus.

• May be required to undergo background and drug screenings and disclose personal health information or personally identifiable information.

🏝️ Benefits

• Competitive salaries.

• Health insurance.

• 401(k) plan with employer match.

• Paid parental leave.

• Collaborative and innovative work environment.

• Reasonable accommodations for individuals with disabilities.