Payment Integrity Data Mining/recovery Specialist

BLUE CROSS AND BLUE SHIELD OF NEBRASKA Inc

Omaha, Nebraska, US
Fully remote
Review and research pi vendor findings
Reconcile pi vendor monthly billing
Investigate new data mining overpayment concepts
This position is responsible for reviewing and researching all findings from our Payment Integrity (PI) vendors and driving awareness to mitigate future claim overpayments

Job Summary

  • This position is responsible for reviewing and researching all findings from our Payment Integrity (PI) vendors and driving awareness to mitigate future claim overpayments.
  • The individual will reconcile PI vendor monthly billing by maintaining accurate records of all PI vendor accounts, investigate new data mining overpayment concepts for our internal PI team, and recover overpayments that cannot be offset by providers and/or members via outreach communications.
  • We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.

Matching Summary

This position is responsible for reviewing and researching all findings from our Payment Integrity (PI) vendors and driving awareness to mitigate future claim overpayments.

Skills & Requirements

Must-have

  • Review and research PI vendor findings
  • Reconcile PI vendor monthly billing
  • Investigate new data mining overpayment concepts
  • Recover overpayments via outreach
  • Quantify and validate prepay/post pay claims
  • Invoice for vendor fees of PI activities

Nice-to-have

  • Champion health and well-being
  • Optimize business processes
  • Build meaningful career
  • Make powerful impact
  • Forward-thinking professionals

Key Requirements

  • High School Diploma or equivalent
  • Two (2) years health insurance experience
  • One (1) year refund/PI/auditing experience

Work Rights

Not specified

Tailored Resume

Cover Letter