Description:
The Recovery Specialist Associate is responsible for identifying, tracking, and reconciling overpayments made to providers and ensuring that recovery is made and reported under general supervision. Performs all authorized duties in the processing of overpayments allocated to the assigned market consistent with all applicable company and departmental policies.
How You Will Make An Impact
- Effectively support the Subrogation Recovery Operations team.
- Provides exceptional service to member, providers, group administrators and attorneys who are providing information on, or seeking information about third party/worker's compensation subrogation files.
- Identifies, reviews, sets up or closes health insurance subrogation claims via phone, fax, email or mail. For open cases, collects, records and verifies member information, pertinent accident details, attorney information and third-party liability information. Records detailed and accurate file notes obtained from calls or written correspondence.
- Manage high-volume intake calls and correspondence inventory effectively.
- Determine membership eligibility using various job aids and membership systems.
- Responds to calls, letters, faxes and emails from policyholders, agents, vendors and/or providers
- Show initiative and resourcefulness in solving problems and meeting customer needs.
- Develop relationships with other business units and service partners whose assistance, cooperation and support may be needed.
- Adheres to company and department policies and procedures as well as HIPAA regulations.
- Performs other duties as requested or assigned.
Minimum Requirements
Requires H.S. diploma or GED preferred, a minimum 2 years of claims or data entry experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities, And Experiences
- Prior call center experience strongly preferred.
- Medical claims processing experience preferred.
- Proficiency with Microsoft Office products (Outlook, MS Teams, Excel, PowerPoint and Word) and software programs preferred.
- Excellent communications skills both oral and written preferred.
- Prior health care experience preferred.
- Strong problem-solving skills preferred.