Claims Receivables And Recovery Specialist (50627)

Job Description Summary

The Claims Receivables and Recovery Specialist reports to the Supervisor, Payment Integrity, and works with various departments within the company to ensure all open claim receivables, which are results of claim overpayments and/or adjustments, are pursued and collected appropriately. The position is responsible for appropriate approvals, presentations of the receivables for decisions, and process documentation.

Duties And Responsibilities

Receivable & Recovery Support

• Research, review and analyze all overpayments, refunds and voids relating to medical, dental, and vision claims.
• Collect receivables for the Western Growers Assurance Trust (WGAT) and clients of the Third-Party Administrator (TPA) that may be a result of overpayments or claims adjustments by researching, writing letters, and actively making phone calls.
• Process refunds and perform voids and reissues as deemed necessary.
• Review, research and analyze statistical data relating to claim history.
• Research and respond to inquiries from other departments related to claim financial transactions within the required agreed upon turn-around-time.

Reporting

• Run claim open receivables report to review for new and past due overpayments.
• Prepare a monthly report to the management team which provides consistent activity, tracking and performance measures as a result of collections, overpayments, refunds, voids, and allocation of all monies received.
• Prepare reports for accounting to handle processing, approvals for adjustments, void, refunds.
• Assure all documentation is categorized, approvals file and archived upon demand.
• Support, analyze and prepare for auditors and the requested information on a timely manner.
• Prepare presentations of data, clients files, and analysis to obtain approvals to adjust overpayments accordingly.

Process Improvement

• Identify and document root causes of claim overpayments.
• Provide claim overpayment remediation recommendations.
• Participate in ongoing process reviews to eliminate and/or decrease open receivables.

Other

• Utilize all capabilities to satisfy one mission - to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others, be self-accountable, create a positive impact, and be diligent in delivering results.
• Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet.
• Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA-required protection of all confidential/protected client data.
• Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit).
• All other duties as assigned.

Physical Demands/Work Environment

The physical demands and work environment described here represent those that an employee must meet to successfully perform this job's essential functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to communicate with others. The employee frequently is required to move around the office. The employee is often required to use tools, objects, and controls. This noise level in the work environment is usually moderate.