Claims Recovery Analyst I - Payer

Accountabilities

• Learn and apply client-specific claims adjudication systems, member and provider contracts, payment policies, and operational procedures.
• Support the identification, validation, and recovery of healthcare claim overpayments.
• Review claims to verify the accuracy of recovery algorithms and confirm that refunds or adjustments have not already been processed.
• Investigate and resolve disputed overpayments involving clients and healthcare providers while maintaining a professional and constructive relationship.
• Research CMS, Medicaid, provider, member, and client-specific policies to identify new overpayment opportunities and emerging trends.
• Analyze medical and pharmacy claims, provider information, and enrollment data to identify patterns, opportunities, and meaningful insights.
• Support the development and approval of new recovery concepts by preparing relevant information and analysis for management and clients.
• Create and maintain detailed step-by-step documentation for algorithms and processes moved into production.
• Monitor inventory levels, algorithm effectiveness, productivity, and recovery opportunities, providing relevant feedback to management.
• Collaborate with colleagues and leadership to identify process improvements, new opportunities, and innovative solutions.
• Escalate situations that could negatively affect client or provider relationships and help ensure timely resolution.
• Contribute to team goals by completing work efficiently, accurately, and within established quality and production expectations.
• Support the onboarding and development of new analysts when needed while maintaining strong individual performance.
• Represent the organization and its clients professionally in all interactions and communications.

Requirements

• Experience identifying, analyzing, and recovering healthcare claim overpayments is preferred.
• Bachelor’s degree in accounting, business, healthcare, or a related field; equivalent relevant work experience may substitute for educational requirements.
• High school diploma or equivalent is required.
• Strong computer skills and proficiency with Microsoft Excel.
• Strong analytical and problem-solving abilities, with the capacity to interpret complex claims and payment information.
• Excellent written, verbal, and interpersonal communication skills, with the ability to build effective relationships with payers, providers, clients, management, and colleagues.
• Strong organizational and time-management skills, with the ability to manage multiple priorities and meet productivity and quality expectations.
• Ability and willingness to learn, understand, and apply new technologies, systems, and processes.
• Proactive, independent, and results-oriented approach to work.
• Customer- and team-focused mindset, with a genuine interest in contributing to long-term organizational growth.
• Experience with medical claims processing is a plus.
• Experience creating and maintaining complex queries is preferred.
• Ability to concentrate on detailed analytical work, interpret information accurately, and communicate findings effectively in a computer-intensive environment.

Benefits

• Salary: $50,000–$60,000 USD per year.
• Remote work environment.
• Health insurance benefits.
• 401(k) plan with employer match.
• Paid parental leave.
• Collaborative and innovative work environment.
• Opportunity to develop expertise in healthcare claims, payment integrity, analytics, and recovery operations.
• Exposure to payer-provider relationships, claims systems, healthcare policies, and data-driven payment accuracy programs.
• Opportunities to contribute to process improvements, new recovery concepts, and operational innovation.
• Reasonable accommodations are available for qualified individuals with disabilities.