Claims Recovery Examiner

All Care To You

. Comply with all Company and Department Policies and Procedures .

Posted 10/7/2026full-timeRemote • California • United StatesMid-LevelSenior💰 $22 - $28 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in processing Commercial, Medi-Cal, and Medicare claims, with a strong understanding of service/diagnosis coding and compliance with federal and state requirements. Proficient in data tracking, reporting, and maintaining confidentiality while managing multiple tasks in a fast-paced environment.

Highest-signal resume keywords

Claims Processing ExperienceService/Diagnosis CodingEz-Cap ExperienceMicrosoft Office ProficiencyProblem-Solving Skills

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims Audit ActivitiesBank ReconciliationRefund ProcessingData TrackingMedical Terminology Knowledge

Soft Skills

Detail OrientedHighly OrganizedStrong Time ManagementStrong Written CommunicationStrong Verbal Communication

Tools & Technologies

OutlookMicrosoft TeamsZoomAdobe

Industry Keywords

Claims Rules and RegulationsGovernment Agency ClaimsConfidential EnvironmentMulti-TaskingProject Management

About the role

Key responsibilities & impact

Comply with all Company and Department Policies and Procedures
Assist in claims audit activities when needed
Review incoming recovery checks, close paid recoveries, and follow up with providers regarding outstanding recoveries
Assist the Finance team with matching bank transactions and bank reconciliations
Process and post daily refund checks
Prepare weekly and monthly reports to management regarding refund requests and refunds received
Prepare monthly reconciled reports of refund checks with Accounts Receivables for management and IPA analysts
Review refund requests for correct amount and reason
Extract and report claim information for data tracking
Prepare and mail refund request letters to providers
Update claim notes and documentation with refund requests and refunds received information
Review, report, and re-request letters of overpayment sent out 30 or more days
Investigate and follow up on claims issues regarding overpayments
Verify providers’ pending claims for recoupment by offset
Recover money owed by providers on claims by offset
Investigate and follow up on provider requests
Coordinate daily with claims, finance, IT, provider network, eligibility, and other departments
Facilitate calls as needed to verify or research claims refund information
Resolve claims issues involving processing errors and recommend improvements to avoid errors
Support claims team members with other duties upon request
Support other departments as needed
Perform all other duties as assigned

Requirements

What you’ll need

Five years’ experience processing Commercial, Medi-Cal and/or Medicare or other government agency claims
Service/Diagnosis coding experience
Knowledge of claims rules and regulation turnaround timeframes by line of business
Ez-Cap experience preferred
Proficient with all Federal and state requirements in claim processing
Knowledge of medical terminology and coding
Proficiency using Outlook, Microsoft Teams, Zoom, Microsoft Office (including Word and Excel), and Adobe
Detail oriented and highly organized
Strong ability to multi-task, project management, and work in a fast-paced environment
Strong ability in problem-solving
Ability to self-manage and strong time management skills
Ability to work in an extremely confidential environment
Strong written and verbal communication skills

Benefits

Comp & perks

Fully remote work environment
Flexible work environment and schedules
100% employer-paid medical coverage
100% employer-paid vision coverage
100% employer-paid dental coverage
100% employer-paid life coverage
Paid holidays
Paid sick time
Paid vacation time
401(k) plan
Additional employee-paid coverage options