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 PI vendor findings
Reconcile PI vendor billing
Investigate data mining concepts
Recover overpayments
Validate prepay/post pay claims
Invoice for vendor fees
Nice-to-have
Champion health and well-being
Optimize business processes
Forward-thinking professional
Meaningful career impact
Key Requirements
High School Diploma or equivalent
Two (2) years of experience in a health insurance field
One (1) year refund, Payment Integrity, and/or auditing experience