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Claims Recovery Analyst

3 months ago

French Camp, United States SAN JOAQUIN COUNTY HEALTH COMMISSION Full time

We are hiring a Claims Recovery Analyst to join our team_

**_ Must reside in California - Remote._**

**Join our team as our new **_Claims Recovery Analyst _**with Health Plan of San Joaquin**

**What You Will Be Doing**:

- Under general supervision, responsible for researching, resolving, pursuing, and processing refund requests, and/or identifying payment error patterns and trends resulting in overpayment of claims.

**Our Vision**:

- Continuously improve the health of our community.

**Our Mission**:

- We provide healthcare value and advance wellness through community partnerships.

**Essential Functions**:

- Research claims to validate overpayments.
- Verifies accuracy and receipt of information.
- Identifies claims error patterns and trends resulting in overpayments.
- Initiates recovery of overpayments in writing, clearly outlining the reason for the refund request.
- Monitors recovery requests; follows up and escalates as required.
- Processes recoveries based on established procedures.
- Posts and applies refunds to appropriate claims.
- Creates and submits detailed reports, including outcome reports.

**What You Bring**:
**Knowledge, Skills, Abilities and Competencies**

**Required**:

- In-depth knowledge of regulations governing Medi-Cal as they relate to claims processing.
- In-depth knowledge of general medical policy benefits and exclusions.
- In-depth knowledge of industry standard payment practices and HPSJ systems as they relate to claims processing.
- Basic knowledge of data analysis and communication/reporting tools and techniques, with ability to perform analysis and resolve problems of moderate complexity and recognize and act on trends.
- Produces work that is accurate and complete, and appropriate amount of work. Actively learns through experimentation when tackling new problems, using both successes and failures to learn.
- Rebounds from setbacks and adversity when facing difficult situations.
- Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
- Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.
- Strong oral and written communication skills, with ability to express self clearly and professionally, with appropriate grammar and spelling, and document according to standards.
- Ability to work independently and as part of a team.
- Strong organizational skills, with the ability to prioritize and complete a wide variety of tasks.
- Basic problem solving and analytical skills, including the ability to perform routine analysis and solve problems using identified data and information.
- Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates his/her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines.
- Basic arithmetic skills. Basic skills in Windows, Excel, Word, and Outlook.
- Ability to handle confidential information with appropriate discretion.
- Ability to speak and be understood in English.

**What You Have**:
**Education and Experience**
- Required
- High school diploma or general education degree
- At least one year as an Analyst III or equivalent
- Preferred
- Associate degree Experience in healthcare claims auditing or analysis.

**Licenses, Certifications**
- None required.

**What You Will Get**:

- HPSJ Perks:

- Competitive salary
- Robust and affordable health/dental/vision with choices in providers
- Generous paid time off (starting at 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)
- CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan
- Two flexible spending accounts (FSAs)
- Employer-Paid Term Life and AD&D Insurance
- Employer-Paid Disability Insurance
- Employer-Paid Life Assistance Program
- Health Advocacy
- Supplemental medical, legal, identity theft protection
- Access to exclusive discount mall
- Education and training reimbursement in addition to employer-paid elective learning courses.
- A chance to work for an organization that is mission-driven - our members and community are at the core of everything we do.
- A shorter commute - if you’re commuting from the Central Valley to the Bay Area.
- Visibility and variety - you have a chance to work with people at all levels of the organization, and work on diverse projects.
- We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit._- Important Notice_: This job description is not a contract between HPSJ and the employee perform