Claims Recovery Specialist

Summary

Join Oscar's Payment Integrity team as a Claims Recovery Specialist! You will be responsible for identifying and recovering overpaid claims from healthcare providers. This role involves analyzing claims data, communicating with providers, and maintaining accurate records. The position requires experience in claims processing, auditing, or healthcare operations, along with strong communication skills. While based in New York City, Tempe, or Los Angeles, this role offers a blended work culture with remote options. Competitive pay and a comprehensive benefits package are included.

Requirements

• 2+ years of experience in claims processing, auditing or health care operations
• 2+ years experience recovery and/or billing experience
• 2+ years of experience working with large data sets using excel or similar
• Customer service and/or provider communication experience

Responsibilities

• Analyze, investigate claims data to determine the root cause of an identified overpayment
• Communicate effectively with healthcare providers to recover identified overpayment
• Prepare and submit notification letters, supporting documentation, and any necessary forms to pursue maximum reimbursement
• Maintain accurate records of claim status, correspondence, and resolution efforts using designated software systems
• Stay informed about changes in health insurance regulations, coding guidelines, and reimbursement policies to ensure compliance and optimize claim recovery strategies
• Compliance with all applicable laws and regulations
• Other duties as assigned

Preferred Qualifications

• Some coding experience or database language exposure
• 2+ years of related work experience in analytics or operations

Benefits

• Medical, dental, and vision benefits
• 11 paid holidays
• Paid sick time
• Paid parental leave
• 401(k) plan participation
• Life and disability insurance
• Paid wellness time and reimbursements