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Recovery Analyst The candidate will be responsible for coordinating claims payment among health plan and another responsible insurance carrier(s). Review payment ledgers from other insurance and determine whether duplicate payments were made. Make demands of other insurance carriers arguing primacy of coverage. Research and request case information to develop cases. Place parties of interest on notice. Maintain a calendar diary to monitor case activity. Respond timely to all electronic, written and verbal communications. Log information derived from written and verbal communication; where required maintain. Pursue worker''s compensation, first and third party, med-pay coverage and no-fault recoveries. Engage advice and/or help of Management to proactively resolve cases. Understand basic health plan contractual provisions and apply to the reimbursement efforts. Ensure compliance of state and federal laws. Train and mentor peers. Provide feedback to Management and unit on trends or developments. Sensitivity to privacy in accordance with HIPAA guidelines. Must have advanced knowledge of subrogation/coordination process; involves making a large amount of outgoing phone calls. Required Experience: Insurance adjuster, health insurance claims experience a plus; Paralegal/Legal Assistant certificate or equivalent experience applicable; Developed customer service skills; Strong organizational and time management skills; Ability to work independently and as part of a team; Working knowledge of Microsoft Word, Excel, internet research skills.
Tracking Code: 420-124
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