Claims Recovery Analyst I - Payer

Trend Health Partners

. Acquire knowledge of clients’ claims adjudication systems, member and provider contracts, and claim payment policies and procedures .

Posted 11/7/2026full-timeRemote • United StatesMid-LevelSenior💰 $50,000 - $60,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in claims adjudication systems and the analysis and recovery of claim overpayments, with strong proficiency in Excel and effective communication skills. Capable of interpreting medical and pharmacy claims data to identify trends and opportunities for improvement.

Highest-signal resume keywords

Claims Adjudication SystemsClaim Overpayment RecoveryExcel ProficiencyAnalytical SkillsMedical Claims Processing

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AnalysisData InterpretationAlgorithm ValidationComplex Query CreationClaims Processing Policies

Soft Skills

Communication SkillsInterpersonal SkillsOrganizational SkillsProblem-Solving SkillsTime Management Skills

Certifications & Qualifications

Bachelor’s Degree in AccountingBachelor’s Degree in BusinessBachelor’s Degree in Healthcare

Industry Keywords

CMS Claims ProcessingMedicaid Claims ProcessingProvider ContractsMember ContractsClaim Payment Policies

About the role

Key responsibilities & impact

Acquire knowledge of clients’ claims adjudication systems, member and provider contracts, and claim payment policies and procedures
Assist clients in identifying, validating, and recovering claim overpayments
Validate claims for algorithm accuracy and confirm no refund has previously been posted
Review and resolve disputed overpayments from clients/providers
Participate in knowledge sharing to resolve claim issues and obtain clarifications
Identify overpayment opportunities and trends by researching CMS and Medicaid claims processing policies, client adjustments, claims systems, and provider/member contracts
Interpret and analyze medical, pharmacy claims, provider, and enrollment data to identify trends and opportunities
Assist Management with concept approval information for client approval
Complete step-by-step instructions for algorithms moved to production
Represent Trend and its clients professionally
Cooperate with team members to meet goals and complete tasks efficiently
Provide Management feedback on inventory levels, algorithm effectiveness/productivity, and new trends or ideas
Collaborate with Management to identify opportunities, improvements, and innovative solutions
Escalate situations that could adversely impact business relationships
Train and assist new analysts while maintaining quality and production results
Perform other duties as assigned

Requirements

What you’ll need

Experience in identification, analysis, and recovery of claim overpayments
Bachelor’s degree in accounting, business, healthcare, or a related field
Equivalent work experience in a similar position may be substituted for educational requirements
High School Diploma or Equivalent Required
Excellent computer skills and proficiency in Excel
Strong communication and interpersonal skills
Strong analytical and problem-solving skills
Effective organization and time management skills
Ability to learn, understand, and apply new technologies
Experience with medical claims processing preferred
Experience creating and maintaining complex queries preferred
May be required to complete background and drug screenings and disclose personal health information or personally identifiable information

Benefits

Comp & perks

Competitive salaries
Health insurance
401(k) plan with employer match
Paid parental leave
Collaborative and innovative work environment
Reasonable accommodations for individuals with disabilities