Specialist, Claims Recovery (Remote)

JOB DESCRIPTION Job Summary Provides support for claims recovery activities including researching claim payment and billing guidelines, audit results, and federal regulations to determine overpayment accuracy and provider compliance. Collaborates with health plans and vendors to facilitate recovery of outstanding overpayments. Monitors and controls backlog and workflow of claims and ensures that claims are settled in a timely fashion and in accordance with cost-control standards. Essential Job Duties u2022 Prepares written provider overpayment notifications and provides supporting documentation such as explanation of benefits (EOBs), claims and attachments. u2022 Maintains and reconciles department reports for outstanding payments collected, past-due overpayments, uncollectible claims and autopayment recoveries. u2022 Prepares and provides write-off documents that are deemed uncollectible, and ensures collections efforts are exhausted for write-off approval. u2022 Researches simple to complex claims payments using tools such as Department of Health and Human Services (DSHS) and Medicare billing guidelines, Molina claims processing policies and procedures, and other resources to validate overpayments made to providers. u2022 Completes basic validation prior to offset to include, eligibility, coordination of benefits (COB), standard of care (SOC) and diagnosis-related group (DRG) requests. u2022 Enters and updates recovery applications and claim systems for multiple states and prepares/creates overpayment notification letters with accuracy; processes claims as a refund or auto debit in claim systems and in recovery application. u2022 Follows department processing policies and procedures including, claims processing (claim reversals and adjustments), claim recovery (refund request letters, refund checks, claim reversals), and reporting and documentation of recovery as explained in departmental Standard Operating Procedures (SOPs). u2022 Responds to provider correspondence related to claims recovery requests and provider remittances where recovery has occurred. u2022 Collaborates with finance to complete accurate and timely posting of provider and vendor refund checks and manual check requests to reimburse providers. u2022 Supports claims department initiatives to improve overall claims function efficiency. u2022 Meets claims department quality and production standards. u2022 Completes basic claims projects as assigned. Required Qualifications u2022 At least 1 year of experience in a clerical role in a claims, and/or customer service setting - preferably in managed care, or equivalent combination of relevant education and experience. u2022 Research and data entry skills. u2022 Organizational skills and attention to detail. u2022 Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. u2022 Customer service experience. u2022 Effective verbal and written communication skills. u2022 Microsoft Office suite and applicable software programs proficiency. Preferred Qualifications u2022 Claims recovery experience. u2022 Health insurance experience in a managed care setting. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.16 - $34.88 / HOURLY Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Created: 2025-12-04