**Resp & Qualifications**

**PURPOSE:**
Under minimal supervision, the Claims Recovery Specialist II review and audits medical and/or dental claims to recover payments. Specialist will assist to maximize recovery amounts due to refund of payments made in error to members and/or providers, retro terms and/or focused provider audits. Specialist will provide day-to-day management of active overpayment recoveries. This position will work closely with the claims, service, finance, and vendor auditing departments to complete claims adjustments.

**ESSENTIAL FUNCTIONS:**

+ Under supervision, reviews, audits, and/or initiates recovery efforts for medical, and/or dental claims to recover overpayments, ensuring all parts of the process are documented properly.
+ Contacts carriers, members and/or providers, via phone, email, and correspondence, to recover and settle overpaid and/or unpaid claims. Responds to carrier, customer and/or provider service inquiries regard...