Senior Specialist, Claims Recovery - Remote

JOB DESCRIPTION Job Summary
Provides senior level 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 notification and supporting documentation such as explanation of benefits (EOB), claims and attachments.
• Maintains and reconciles department reports for outstanding payment, 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 complex cla...