Over Payment Recovery Specialist
Expired Job Description :
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Job Summary:
This position is responsible for focusing on overpayment claimants activities and coordinating with care delivery related areas of the company. Assures overpayment claimants are address across the company and throughout the care delivery system.
Responsibilities:
- Identifying, validating, pursuing and recovering benefit claim overpayments.
- Manage overpayment claimants within established customers.
- Identify overpayment claimants within prospective customers.
- Lead overpayment mitigation efforts to ensure overpayments are corrected.
- Input overpayments in tracking system and adjusting claims as refunds are received.
- Sending provider reversals for claim overpayments and tracking status.
- Maintaining and investigating participants with terminated diagnoses related to services provided.
- Processing requests for information and answering inquiries regarding overpayments of benefits from other departments, participants and providers.
- Updating claims system notes and sending out requested forms, documents, claim details and other information as needed.
- High School Diploma/GED required.
- Minimum of four (4) years experience in an operational role, or analytical role.
- Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Word/Excel/Access email application systems experience claims process and knowledge of FASCET is required.
- Prefer knowledge of multiple lines of claim processing systems, including data entry pend resolution, adjustments and inquiry skills.
- Proven ability to exercise sound judgment and strong creative problem solving. skills, along with the ability to identify continual improvement opportunities.
- Must be detail oriented with strong follow-up skills.
- Excellent verbal and written communication skills, including the ability to communicate with internal and external customers. Ability to represent the team in cross-functional meetings and workgroup sessions to identify improvement opportunities. Demonstrated ability to explain complex information.
- Needs to demonstrate willingness to cross-train, and be cross-trained, in other roles/duties.
- Requires excellent typing skills.
- Requires excellent oral and written communication skills.
- Requires excellent PC skills, particularly in MS Office (Excel, PowerPoint, Word).
- Requires excellent organizational skills.
- Requires excellent interpersonal skills.
- Requires strong conflict resolution skills.
- Requires the ability to effectively interact with all levels of the or
- Comprehensive health benefits (Medical/Dental/Vision)
- Retirement Plans
- Generous PTO
- Incentive Plans
- Wellness Programs
- Paid Volunteer Time Off
- Tuition Reimbursement
