Claims Overpayment Recovery Specialist

Unite Here Health • Aurora, IL

398d • $42,245 - $51,834 • Remote

About The Position

The Overpayment Recovery Specialist is responsible for validating and recouping outstanding overpayments for the Claims Department in a timely manner. This role involves managing the overpayment log, verifying recorded overpayment amounts, and coordinating claims adjustments related to recovered overpayments. The specialist will communicate with providers and prepare reports for the Leadership Team regarding outstanding overpayments.

Requirements

• 2 ~ 4 years of direct overpayment recovery experience required
• 1 ~ 2 years of claims adjudication experience on a web-based platform, preferred
• Knowledge of CPT, ICD-10 and medical terminology, preferred

Responsibilities

• Validate the amounts entered on the Overpayment spreadsheet to ensure the accuracy of requested amounts.
• Pursue benefit claim overpayments within the timelines established by UHH or the PPO network to ensure timely collection of identified recoveries.
• Record overpayments in the tracking system and confirm that claims are adjusted as overpayments are received.
• Communicate via email, letter, phone, or other methods with PPOs, members, and out-of-network providers for the recovery of outstanding overpayments.
• Prepare data for presentation to the Leadership Team on outstanding overpayments.
• Present monthly overpayment status reports by fund, detailing received and outstanding overpayments by year and PPO.
• Process claims and adjustments efficiently.
• Identify opportunities for process improvement and present recommendations to management.
• Assist with the implementation of new processes.
• Identify and document the root causes of claims overpayments.
• Provide remediation recommendations regarding claims overpayments to Claims leadership.

Benefits

• Medical
• Dental
• Vision
• Paid Time-Off (PTO)
• Paid Holidays
• 401(k)
• Pension
• Short- & Long-term Disability
• Life Insurance
• AD&D
• Flexible Spending Accounts (healthcare & dependent care)
• Commuter Transit
• Tuition Assistance
• Employee Assistance Program (EAP)

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Personal and Laundry Services
• Education Level: No Education Listed