Payments & Recovery Specialist

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

📋 Description

• Review and validate medical invoices from global hospitals, clinics, physicians, and other healthcare providers.

• Confirm patient information, treatment dates, medical services, invoice precision, and accompanying documentation.

• Assess medical charges for fairness and identify instances of duplicate billing, inflated costs, unnecessary services, and billing inconsistencies.

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

• Coordinate payments with the Finance team to ensure invoices are approved, documented, and settled within stipulated timelines.

• Verify international banking instructions, beneficiary details, SWIFT/IBAN data, and payment prerequisites prior to releasing payments.

• Maintain payment records, monitor outstanding invoices, and address provider payment disputes.

• Ensure that deductibles, patient obligations, and agreed discounts are applied accurately.

• Investigate 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 medical invoices and contest questionable treatment costs, procedures, and lengths of stay.

• Identify opportunities to enhance provider payment terms and negotiate improved commercial arrangements.

• Monitor negotiated savings and report cost containment outcomes to management and insurance partners.

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

• Identify opportunities to recover medical and claims expenses from liable third parties, insurers, and other sources.

• Investigate liability related to accidents, hotels, transportation providers, medical facilities, and other third parties.

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

• Review accident reports, police documentation, insurance policies, medical records, and other evidence for recovery.

• Pursue coordination of benefits and recoveries from primary or overlapping insurance coverages.

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

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

• Maintain subrogation records and report recovery outcomes to insurance partners.

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

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

• Identify suspicious patterns including repeat admissions, inflated treatment charges, altered invoices, and unusual payment arrangements.

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

• Collaborate with Fraud and Claims teams to examine suspicious claims and recommend suitable actions.

• Document investigation findings and maintain evidence that supports payment or recovery decisions.

• Keep records of payments, negotiations, recoveries, and investigations within 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 process enhancements and opportunities to automate invoice review, verification, and payment workflows.

• Assist in developing procedures for international provider payments, cost containment, and subrogation.

⛳️ Requirements

• Over 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 involving international healthcare providers.

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

• Strong negotiation skills and confidence in disputing unreasonable charges and resolving conflicts.

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

• Ability to examine medical documentation, financial records, and insurance policies effectively.

• Strong investigative and analytical abilities with exceptional attention to detail.

• Excellent written and verbal communication skills in English.

• Comfortable working independently and managing multiple complex cases concurrently.

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

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

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

• Previous experience in 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 recovery strategies.

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

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

• Direct financial and operational impact through your role.