February 24, 2015
Auditor and Recovery Specialist
We are looking for bright and energetic individuals to be an Auditor and Recovery Specialist.
- Auditing processed claims and providing feedback to the processors
- Analyzing auditing results for trends and identification of areas where additional training may be needed
- The recovery of overpaid claims through refund request or recoupment
- Reporting potential re-insurance claims and filing actual claims
- Complete review of processed claims, tracking the necessary details to provide feedback to the processors on correct/incorrect claim handling as well as provide monthly statistics on a procedural and financial basis
- Request refunds via written request or recoupment of overpaid claims, as directed by the client
- Maintain logs of refunds and recoupment’s as well as refund checks received and processed
- Process refund checks in claim system according to guidelines
- Send follow-up requests on outstanding overpayments at required intervals
- Request and review monthly reports for potential re-insurance claims and report to client
- File re-insurance claims when limits reached on potential reports
- Serve as back-up for check run process
- Assist in claim query write-up’s within the claim paying system
- Other duties as assigned
- Extensive experience in health insurance claims processing with a minimum 5 years experience
- HMO Claims or managed care environment preferred
Valence Health is an equal opportunity employer welcoming diversity in our workforce!
This is a continuous recruitment to identify candidates for our Auditor and Recovery Specialist position.