Responsibilities
- Gather and review medical claims records, overpayment files, and documentation tied to subrogation and non-standard agreement (NSA) inquiries.
- Conduct investigations into claims using internal systems and external resources to validate recovery eligibility for overpayment, subrogation, and NSA cases.
- Engage with internal teams and external partners to confirm adherence to recovery protocols and timelines.
- Track and manage daily and weekly case loads to meet internal performance benchmarks and regulatory deadlines.
- Spot trends and inefficiencies in recovery processes and suggest improvements in areas such as policy updates, network agreements, cost control, and operational effectiveness.
- Communicate recovery claims to third-party vendors and clients, coordinating discussions around settlements or next steps.
- Act as a liaison in recovery-related meetings, including leading discussions between external vendors and clients to secure final approvals.
- Ensure accurate logging and documentation of all appeals and complaints in compliance with data standards.
- Complete additional assignments as directed by leadership.
Work Arrangement
Hybrid
