Claims Examiner

• 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

Explore Claims Recovery Examiner at All Care To You. Review requirements and application details.