Address
Form of work
SalaryResp & Qualifications
PURPOSE:
Under direct supervision, the Claims Recovery Specialist I reviews and audits medical claims to recover payments. Specialist will work to maximize recovery amounts due to refund of payments made in error to providers, retro terms, and focused provider audits.
ESSENTIAL FUNCTIONS:
- Contacts carriers to recover and settle unpaid claims. Responds to carrier inquiries regarding outstanding claims.
- Adjusts claims to reflect cash returned by providers and subscribers in order to reduce and accurately reconcile customer accounts.
Distributes written correspondence to policy holders in order to recoup overpaid claims, negotiate repayment agreements when necessary, and ultimately reduce the companys care line.
QUALIFICATIONS:
Education Level: High School Diploma or GED.
Experience: 3 years claims processing.
Knowledge, Skills and Abilities (KSAs)
- Mathematical ability/aptitude.
- Communication skills.
- Ability to deal with both internal and external clients.
Salary Range: $32,544 - $59,664
Salary Range Disclaimer
The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
Department
Facets Coordination of Benefit
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Where To Apply
PeopleSoft/Self Service/Recruiting
Closing Date
Please apply before:01/07/2025
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship.
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