Payments & Recovery Specialist

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

📋 Description

• Assess and authenticate medical invoices from hospitals, clinics, physicians, and various healthcare providers globally.

• Confirm patient information, treatment dates, medical services, invoice accuracy, and supporting documentation.

• Detect duplicate billing, inflated costs, unnecessary services, and inconsistencies in billing.

• Negotiate medical bills, discounts, and final settlements with international providers.

• Collaborate with the Finance department to ensure invoices are approved, documented, and paid punctually.

• Verify international banking instructions, beneficiary information, SWIFT/IBAN details, and payment requirements.

• Keep payment records, monitor outstanding invoices, and resolve payment disputes with providers.

• Accurately apply deductibles, patient responsibilities, and agreed discounts.

• Research local medical pricing and benchmark charges against reasonable and customary costs.

• Negotiate with hospitals, medical networks, and billing intermediaries to minimize medical expenses.

• Review high-value invoices and contest questionable treatment costs, procedures, and lengths of stay.

• Track negotiated savings and report cost containment results to management and insurance partners.

• Escalate unusual billing patterns, excessive charges, or suspected misconduct by providers.

• Identify and investigate recovery and subrogation opportunities involving responsible third parties, insurers, accidents, hotels, transportation providers, and medical facilities.

• Coordinate recovery efforts with liability insurers, legal representatives, and international claims organizations.

• Review accident reports, police documentation, insurance policies, medical records, and supporting evidence.

• Prepare recovery demands, negotiate settlements, and monitor outstanding recovery balances.

• Collaborate with external legal counsel when formal recovery or litigation is necessary.

• Investigate potentially fraudulent medical invoices, fabricated documentation, and suspicious payment requests.

• Verify the legitimacy of hospitals, provider credentials, patient admissions, and medical billing information.

• Conduct provider due diligence using independent sources, official records, and direct hospital verification.

• Work together with Fraud and Claims teams to document investigation findings.

• Maintain records of payments, negotiations, recoveries, and investigations in claims management systems.

• Monitor outstanding payment obligations, recovery opportunities, and overdue cases.

• Prepare reports on payment volumes, negotiated savings, recovery performance, and suspected fraud.

• Identify opportunities for process improvements and automation in invoice review, verification, and payment workflows.

• Support internal procedures related to international provider payments, cost containment, and subrogation.

⛳️ Requirements

• Minimum of 3 years of experience in travel insurance, medical assistance, claims administration, healthcare billing, cost containment, or insurance recoveries.

• Experience in reviewing and negotiating medical invoices, preferably with international healthcare providers.

• Solid understanding of insurance claims, medical billing, subrogation, and coordination of benefits.

• Strong negotiation abilities and confidence in challenging unreasonable charges and resolving disputes.

• Familiarity with international payments, banking verification, and cross-border transactions.

• Capability to review medical documentation, financial records, and insurance policies.

• Strong investigative and analytical skills with a keen eye for detail.

• Excellent written and verbal communication skills in English.

• Ability to work independently while managing multiple complex cases simultaneously.

• Proficiency in claims management systems, spreadsheets, and digital collaboration tools.

• Willingness to work across international time zones and engage with providers worldwide.

• Experience in a travel insurance company, third-party administrator (TPA), medical assistance company, or international medical cost containment organization.

• Previous responsibilities related to medical bill negotiation, provider fraud investigations, or subrogation recoveries.

• Familiarity with international healthcare systems and medical pricing.

• Experience collaborating with external legal counsel and liability insurers.

• Proficiency in additional languages, especially Spanish, French, or Portuguese.

• Experience utilizing AI tools, document analysis, and automated verification systems.

🏝️ Benefits

• Opportunity to take ownership of complex international cases.

• Opportunity to negotiate with providers globally.

• Opportunity to develop innovative recovery strategies.

• Opportunity to contribute to smarter, technology-driven payment and fraud prevention processes.

• Work within a rapidly growing international insurance and assistance business.

• Direct financial and operational impact.