Claims Recovery Examiner

Posted 6 Hours Ago
Be an Early Applicant
Hiring Remotely in Albuquerque, NM, USA
In-Office or Remote
18-28 Hourly
Junior
Healthtech • Insurance
The Role
Researches refund checks, out-of-balance entries, and non-negotiated checks, determining whether provider payments should be offset, voided, or reissued. Applies knowledge of healthcare reimbursement methodologies, complex pricing, contract pricing, and coordination of benefits. Requires strong mathematics, organization, problem-solving, analytical, teamwork, and time-management skills.
Summary Generated by Built In

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

Under supervision, this position is responsible for researching refund checks, out of balance entries and non-negotiated checks. The research may result in action including offsetting, voiding or reissuing provider checks. The processes require knowledge of complex pricing, contract pricing and coordination of benefits.
Job Requirements
* High school graduate or GED.
* 1 year experience of coordination of benefits (COB) experience
* Ability to determine health care reimbursement methodologies and coordinate benefits.
* Organizational and time management skills; flexibility in dealing with changing priorities.
* Team skills, including the ability to work with other or work independently as warranted by the task.
* Strong mathematical skills.
* Strong problem solving and analytical skills.
Preferred Job Requirements
* 2 years progressive responsibility in IHS Department claims processing or Customer Service areas.
* 2 years of accounting experience or good understanding of accounting practices or 2 years of progressive responsibility in claims processing to include COB processing.
Preference in filling vacancies is given to qualified Indian candidates in accordance with the Indian Preference Act of 1934 (title 25, USC Section 472) Native American Indian Preference shall apply to this position pursuant to the Indian Self-Determination and Education Assistance Act (24 U.S.C. 450, et seq.), 25 CFR 271.44 and other relevant laws (title 25,
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Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees.  Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range$17.75 - $28.39

Exact compensation may vary based on skills, experience, and location.

Skills Required

  • High school diploma or GED
  • 1 year of coordination of benefits experience
  • Ability to determine healthcare reimbursement methodologies and coordinate benefits
  • Organizational and time-management skills
  • Flexibility in dealing with changing priorities
  • Ability to work independently and collaboratively
  • Strong mathematical skills
  • Strong problem-solving and analytical skills
  • 2 years of progressive responsibility in IHS claims processing or customer service
  • 2 years of accounting experience or good understanding of accounting practices
  • 2 years of progressive responsibility in claims processing, including coordination of benefits processing

Health Care Service Corporation Compensation & Benefits Highlights

The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Health Care Service Corporation and has not been reviewed or approved by Health Care Service Corporation.

  • Retirement Support A pension plan alongside a matching 401(k) is offered, an uncommon combination in the private sector. This combination is described as a standout element that helps retain employees.
  • Healthcare Strength Healthcare options are broad, with multiple medical, dental, and vision choices, wellness incentives, and access to resources like on-site fitness centers and an EAP. These offerings add meaningful value beyond base pay.
  • Parental & Family Support Paid parental leave (up to six weeks at full pay after one year), adoption assistance, and mothers’ rooms are available. These supports reinforce family needs alongside work commitments.

Health Care Service Corporation Insights

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The Company
HQ: Chicago, IL
13,563 Employees

What We Do

Imagine Something New, Something Different. Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), is the largest customer-owned health insurer in the nation and the fourth largest overall. Operating through our Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas (as well as a variety of affiliates and subsidiaries,) we are expanding access to high-quality, cost-effective health care. We are equipping members with information and tools so they can make the best health care decisions for themselves and their families. HCSC is continuously recognized as an employer committed to community, diversity and inclusion, training and development. HCSC is committed to pioneering the health care space in ways as effective as they are creative. If you are passionate about the impact you want to have through your work, with a desire to apply innovative thinking to new and emerging challenges, we encourage you to learn more about HCSC. Learn about what we stand for, how we work and the difference we’re making in the lives of our 15 million members. Join HCSC and discover what new ways of thinking can mean for you, your community, our customers and our organization. Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.

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