Current jobs related to Insurance Collections Services Associate IV - Remote - Conduent Payment Integrity Solution Inc.

  • Insurance and Financial Services Consultant

    4 days ago

    Remote, Oregon, United States Financial Services & Insurance Company Full time

    Exciting Role as an Insurance and Financial Services ConsultantWe are seeking a dedicated professional to join our organization, a prominent player in the Financial Services and Insurance sector. As an Insurance and Financial Services Consultant, you will have the opportunity to cultivate your practice, receive exceptional training, and provide a range of...

  • Pet Insurance Customer Service Associate

    3 weeks ago

    Remote, United States Midatlantic Employers' Association Full time $20 - $21

    Job DescriptionJob DescriptionMember Experience Associate*Property & Casualty License required to apply.*This is a commission eligible position.Our client, Fetch Pet Insurance, is a tech-enabled pet wellness company, has consistently been an innovative leader in the pet insurance industry, offering the most extensive and all-inclusive pet insurance and...

  • Financial Advisor-Insurance Life/Health Agent

    3 months ago

    Remote, United States Financial Services & Insurance Company Full time

    Job DescriptionJob DescriptionOur parent company is Aegon, $553 billion company. We are a full service Financial Services and Insurance firm in a state/federal regulated industry, that provides an opportunity for agents to build a business, receive extensive training to learn the business and industry. We offer investments and Insurance products to our...

  • Commercial Insurance Sales Executive

    3 weeks ago

    Remote, Oregon, United States Brown & Brown Insurance Full time

    Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers.The Commercial Insurance Sales Executive isn't a normal insurance job. Let's face it. There are a lot of stereotypes about a career in insurance (especially that junk about 100% commission jobs). That's not Arrowhead We...

  • Member Experience Associate

    3 weeks ago

    Remote, United States Midatlantic Employers' Association Full time $20 - $21

    Job DescriptionJob DescriptionMember Experience Associate*Property & Casualty License required to apply.*This is a commission eligible position.Our client, Fetch Pet Insurance, is a tech-enabled pet wellness company, has consistently been an innovative leader in the pet insurance industry, offering the most extensive and all-inclusive pet insurance and...

  • Insurance Specialist II

    4 weeks ago

    Remote, Oregon, United States Xtend Healthcare, LLC Full time

    ***Xtend offers competitive benefits including Medical/Dental/Vision, Generous Paid Time Off/Paid Holidays/ Tuition Reimbursement/401k plan plus Employer Match/Professional Development***Xtend Healthcare, a Navient company, is nationally recognized as the industry-leading provider of comprehensive revenue cycle solutions to hospitals and health systems....

  • Insurance Specialist II

    3 weeks ago

    Remote, United States Xtend Healthcare, LLC Full time

    ***Xtend offers competitive benefits including Medical/Dental/Vision, Generous Paid Time Off/Paid Holidays/ Tuition Reimbursement/401k plan plus Employer Match/Professional Development***Xtend Healthcare, a Navient company, is nationally recognized as the industry-leading provider of comprehensive revenue cycle solutions to hospitals and health systems....

  • Senior Account Coordinator

    4 weeks ago

    Remote, Oregon, United States Newfront Insurance Full time

    Insurance is a trillion dollar market that is fundamental to society, yet it has not modernized — until now. Newfront is building the modern insurance experience. We've reimagined the experience for clients, prospects, and employees, altering the way people create, understand, select, transact, and use insurance. We're changing the approach so that it...

  • Account Manager

    4 weeks ago

    Remote, Oregon, United States Anzen Insurance Full time

    About Anzen:The $100 billion U.S. specialty insurance market encompasses many of the most challenging and complex insurance risks. Most of this market is still quoted and transacted via email, spreadsheets, phone calls, and PDFs.Retail insurance brokers across the U.S. rely on market making brokers-what the industry calls the wholesale market-to place much...

  • Senior Account Executive

    2 months ago

    Remote, Oregon, United States Newfront Insurance Full time

    Insurance is a trillion dollar market that is fundamental to society, yet it has not modernized — until now. Newfront is building the modern insurance experience. We've reimagined the experience for clients, prospects, and employees, altering the way people create, understand, select, transact, and use insurance. We're changing the approach so that it...

  • Account Manager

    3 weeks ago

    Remote, Oregon, United States Newfront Insurance Full time

    Insurance is a trillion dollar market that is fundamental to society, yet it has not modernized — until now. Newfront is building the modern insurance experience. We've reimagined the experience for clients, prospects, and employees, altering the way people create, understand, select, transact, and use insurance. We're changing the approach so that it...

  • Insurance Claims Specialist

    4 days ago

    Remote, Oregon, United States Midatlantic Employers' Association Full time

    Job OverviewJoin Midatlantic Employers' Association, a leader in the insurance sector, dedicated to providing exceptional service and support to our clients. We are seeking a dedicated Insurance Claims Specialist to enhance our claims processing team.At Midatlantic, we believe in making insurance accessible and straightforward. Our mission is to ensure that...

  • Marketing Associate

    3 weeks ago

    Remote, Oregon, United States EverBody Full time

    Marketing Associate About Ever/Body: Ever/Body is a haven for high-performance beauty services founded around the mission to thoughtfully support everybody along their individual beauty journey. We offer a curated collection of clinically-tested face, body, and hair treatments, delivered with gracious hospitality by our team of expert providers. Through a...

  • Manager of Insurance, Insurance Program

    2 months ago

    Remote, Oregon, United States CIEE Full time

    Who we are: CIEE is a non-profit study abroad and intercultural exchange organization that transforms lives and builds bridges between individuals and nations through study abroad and international exchange experiences that help people develop skills for living in a globally interdependent and culturally diverse world.Why work with us: You will change the...

  • Associate, Enrollment

    2 months ago

    Remote, Oregon, United States Strive Health Full time

    What We Strive For Strive Health is built for purpose — to transform a broken kidney care system. We are fundamentally changing the lives of people with kidney disease through early identification, engagement and comprehensive coordinated care. Strive's model is driven by a high-touch care team that integrates with local providers and spans the entire care...

  • Account Manager

    2 months ago

    Remote, Oregon, United States Newfront Insurance Full time

    Insurance is a trillion dollar market that is fundamental to society, yet it has not modernized — until now. Newfront is building the modern insurance experience. We've reimagined the experience for clients, prospects, and employees, altering the way people create, understand, select, transact, and use insurance. We're changing the approach so that it...

  • Insurance Sales Operations Specialist

    1 week ago

    Remote, Oregon, United States ASK Consulting Full time

    Job OverviewPosition Title: Insurance Sales Operations SpecialistContract Duration: 9 MonthsWork Arrangement: Fully RemoteCompensation: $25 - $28 per hour on W2Work from home - Candidates in the Eastern Standard Time zone are preferred.Role Summary:The Insurance Sales Operations Specialist will play a vital role within the Producer Operations team, focusing...

  • Insurance Industry Lead

    1 month ago

    Remote, Oregon, United States Quantexa Full time

    DescriptionWhat we're all about.Do you strive to make a difference to the insurance industry? To support technology innovation and change which drives business growth, more trusted risk management and greater customer centricity with the use of data and AI? At Quantexa, we do.This desire to improve the industry for our clients and partners is what drives us...

  • Client Account Manager

    4 weeks ago

    Remote, Oregon, United States Brown & Brown Insurance Full time

    Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers.The Colonial Group is currently seeking a skilled and motivated Client Account Manager to join our team. This can be a remote from home opportunity. WHAT YOU WILL DO: Build, expand and solidify relationships with clients...

  • Benefits Administration Services Defined Pension Analyst II

    3 weeks ago

    Remote, Oregon, United States Conduent HR Services, LLC Full time

    Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is...

Insurance Collections Services Associate IV

1 month ago

Remote, United States Conduent Payment Integrity Solution Inc. Full time
Job Description

Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.



• Insurance Collections Services Associate IV – Pharmacy (Lead)


Insurance Collections Services Associate IV – Pharmacy is responsible for performing complex tasks according to established procedures, business support or technical work using data organizing and coordination skills to complete assignments. In some areas, requires vocational training, certifications, licensures, or the equivalent experience necessary to seek reimbursement/recovering overpayments from third parties, dispensing pharmacy providers, PBM’s, healthcare facilities and/or insurance carriers on overpaid NCPDP pharmacy drug claims for CPIS clients.  These claim overpayments are a result of incorrectly paid claims arising from COB issues, data mining, duplicate claim payments, client referrals, etc.  The Insurance Collections Services Associate IV – Pharmacy serves as team lead, may allocate work, and provide subject matter guidance to more junior team members. Insurance Collections Services Associate IV – Pharmacy is responsible for meeting all performance standards:  collection goals, compliance, and production to ensure calls are timely, maximum call time is achieved and ensures quality results. Responsibilities include (but are not limited to): 


 



  • Recovery of pharmacy claim overpayments through direct outreach via phone, e-mail, or fax method with pharmacies, PBM’s, insurance carriers.
  • Has advanced and specialized expertise in an analytical method or operational process, typically developed through a combination of training and considerable on-the-job experience.
  •  Completes assignments and facilitates the work activities of others; may coordinate work beyond own area.
  • Proposes improvements to processes and methods.
  • Acts as a lead, coordinating the work of others but is not a supervisor.
  • Works autonomously within established procedures and practices.
  • Develops effective collection approaches and workflows to maximize recovery opportunities.
  • Communicates with plan carrier’s PBM regarding Medicare Secondary Payer requirements, as well as drug exclusions under Medicare Part D. 
  • Analyzes claim overpayments which are a result of incorrectly paid claims arising from COB issues, data mining, duplicate claim payments, client referrals, etc.
  • Coordinates collection efforts between the client and the provider, adjusting claims as required.
  • Collect and seek reimbursement/recover overpayments from third parties, healthcare providers and/or insurance carriers for overpaid Medical Claims for CPIS (Conduent Payment Integrity Services) clients.
  • Communicates directly with healthcare providers to recover the overpayment.   
  • Documents all efforts in the related systems.
  • Handles disputes and appeals from providers and clients.
  • Prepares claims for offset by the client.
  • Interfaces with the client as needed, managing Conduent Payment Integrity Solutions interactive database.
  • Operates independently based on established procedures.
  • Analyzes claim overpayments which are a result of incorrectly paid claims arising from COB issues, data mining, duplicate claim payments, client referrals, etc.
  • Provides support and coaching to less experienced team members.
  • Escalates issue to senior levels as needed based on reports or concerns explaining company policies.
  •  Mentors staff members.
  • Acts as a subject matter expert.
  • Performs complex tasks according to client guidelines.
  • Provides support and coaching to less experienced team members.
  • Escalates issue to senior levels as needed based on reports or concerns explaining company policies.

Experience:



  • Strong background in pharmacy billing concepts, including pharmacy billing and claim recovery (collection) experience.  Extensive knowledge of insurance procedures, working with PBM’s, commercial insurance carriers, Medicare, and Medicaid. 
  • Extensive understanding of:

    • Third-party reimbursement types (i.e. PBM, medication assistance programs, self-pay)
    • Healthcare reimbursement in different settings (i.e., home health, long term care, home infusion, health systems, community pharmacy, and ambulatory clinics.
    • Drug related reimbursement calculations in different forms (i.e., oral/PO, injections, infusions, topicals, etc.)
    • Eligibility verifications surrounding BIN/PCN combinations and payer sheets.
    • Coordination of Benefits (COB) to determine each party’s responsibility.
    • Interpreting EOB’s, ERA’s (electronic remittance advice) for understanding of allowable rates, rejection codes and patient accumulations.
    • CMS guidelines surrounding Medicare Part D, including rejections, external code lists and drug exclusions. 
    • Familiarity with NCPDP claims, NDC’s, and reimbursement terms.

      • Highly experienced in overrides and high-level appeals. 


  • Expertise in specialty market, compounds/infusions, injections and NDC conversions.
  • Professional verbal and written communication skills required.
  • Advanced Excel knowledge required.
  • Minimum 5-year experience with pharmacy billing/insurance collections. 

 


Education: Associate degree or equivalent combination of education and experience. 


Pay Transparency Statement:


Pay transparency laws in some locations require disclosure of compensation-related information. For this position, actual salaries will vary and may be above or below the range based on various factors, including but not limited to location, experience, and performance. In addition to base pay, this position, based on business need, may be eligible for a bonus or incentive.


Furthermore, Conduent provides a variety of benefits to employees, including health insurance coverage, voluntary dental and vision programs, life and disability insurance, a retirement savings plan, paid holidays, and paid time off (PTO) or vacation or sick time.


The estimated salary range for this role is $30 per hour.


 


 


 


 


Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.


People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the "Submit" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form. You may also click here to access Conduent's ADAAA Accommodation Policy.

At Conduent we value the health and safety of our associates, their families and our community. For US applicants while we DO NOT require vaccination for most of our jobs, we DO require that you provide us with your vaccination status, where legally permissible. Providing this information is a requirement of your employment at Conduent.