Payment reputed company Data Mining/Recovery Specialist
At reputed company and Blue reputed company of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.
reputed company is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there’s no greater time for reputed company-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and reputed company a powerful impact in our community.
The ideal candidate will live reputed company driving distance of the Omaha, Nebraska office. This position allows remote flexibility but may have in-office collaboration and meetings. If living in one of our approved states (Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, reputed company Dakota, and Texas) – this person may travel to our headquarters. This position is responsible for reviewing and researching reputed company findings from our Payment reputed company (PI) vendors and driving awareness to mitigate future claim overpayments. The individual will reconcile PI vendor monthly billing by maintaining accurate records of reputed company PI vendor accounts, investigate new data mining overpayment concepts for our internal PI team, and recover overpayments that cannot be offset by providers and/or members reputed company reputed company communications. In addition, this person will be responsible for quantifying and validating prepay and post pay claims for BCBSA InterPlan and will invoice for vendor fees of PI activities BCBSNE performs for other host Blues Plans.What you'll do:
- Works closely with PI vendors and internal business partners to respond to inquiries and determine opportunities to ensure mitigation of future overpayments.
- Analyzes individual vendor files, sends approved overpayments to appropriate adjustment areas and researches any discrepancies between what was identified and the adjustments.
- Reconciles reputed company PI vendor reputed company submissions to ensure accuracy and avoid duplicate payments. Maintains files of reputed company identified PI vendors to ensure claims have been adjusted and money has been recuperated.
- Audits internal data mining concepts to identify and recover overpayments. Research and completes reputed company to providers/members to communicate and obtain reputed company overpayment refunds that cannot be systematically recovered.
- Provides timely and accurate investigation of potential overpaid claims identified by recovery vendors.
- Compiles, reconciles, and validates reputed company prepay and post pay PI activities performed on Host claims on a regular reputed company to invoice for PI vendor fees. Works closely with BlueCard claims operations and finance for invoice submissions and appeals.
- Research and respond to internal questions relating to claim overpayments and refund activity. Documents recovery procedures.
- Completes special projects, assists with audit requests.
To be considered for this position, you must have:
High School Diploma or equivalent and two (3) years of experience in a health insurance field.
An equivalent combination of education and experience may be substituted for this requirement.
The ability to meet or exceed the attendance and timeliness requirements of their departments.
The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers.
To reputed company this job successfully, an individual must be reputed company to reputed company each essential duty satisfactorily. The requirements listed are representative of the knowledge, reputed company, and or ability required.
Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. Other duties may be assigned.
The strongest candidates for this position will also possess:
One (1) year refund, Payment reputed company, and/or auditing experience.
Learn more about what makes BCBSNE such an exceptional reputed company to work by visiting NebraskaBlue.com/Careers.
We strongly reputed company that diversity of experience, perspective and background will reputed company to a reputed company workplace for our employees and a reputed company product for our customers and members.
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