Senior Recovery / Resolutions Representative Job Description
Senior recovery / resolutions representative
provides claims support to our COB (Coordination of Benefits Group) by reviewing, researching, investigating, negotiating and resolving all types of claims related to incorrect or overpayments.
Senior Recovery / Resolutions Representative Duties & Responsibilities
To write an effective senior recovery / resolutions representative job description, begin by listing detailed duties, responsibilities and expectations. We have included senior recovery / resolutions representative job description templates that you can modify and use.
Sample responsibilities for this position include:
Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment)
Negotiation of files to settlement of Trover Solutions client’s interest with attorneys, third parties, adjusters and/or Trover Solutions client’s members
Provide claims expertise support by reviewing, researching, investigating, negotiating, and resolving all types of claims recovery and resolution for health plans, commercial customers, and government entities
Makes fact- based decisions
Provide expertise in credit balance adjudication by reviewing, researching, and resolving all types of accounts providing resolution outcomes for health plans, commercial customers and government entities
Investigate, recover, and resolve all types of claims recovery and resolution for health plans, commercial customers, and government entities
Communicate professionally with the provider to ensure PRS is meeting the needs and expectations of the client
Provide claims expertise support by reviewing, researching, investigating and resolving all types of claims recovery and resolution for health plans, commercial customers, and government entities
Perform Claim adjustments first pass claims processing
Macro Express
Senior Recovery / Resolutions Representative Qualifications
Qualifications for a job description may include education, certification, and experience.
Education for Senior Recovery / Resolutions Representative
Typically a job would require a certain level of education.
Employers hiring for the senior recovery / resolutions representative job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Business, Graduate, Management
Skills for Senior Recovery / Resolutions Representative
Desired skills for senior recovery / resolutions representative include:
COB Rules
Basic Computer skills and business etiquette
Microsoft Excel
Claims processing procedures
Medicaid / Medicare Reimbursement methodologies
Medical terminology
Privacy and government regulations
Systems and contract
/
Desired experience for senior recovery / resolutions representative includes:
2+ years of experience with intermediate level of proficiency with Excel
Work a 40hr work week within the operating hours of Monday-Friday 6am-5pm
1+ year of experience working with computers and Windows PC applications
Experience in medical insurance
Must be able to work a standard 40 hour work week Monday - Friday
Ability to travel 1 to 2 days a month to 2 other local sites located in Warner Robbins, GA and Columbus, GA
Senior Recovery / Resolutions Representative Examples
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Senior Recovery / Resolutions Representative Job Description
Job Description Example
Our company is growing rapidly and is searching for experienced candidates for the position of senior recovery / resolutions representative. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for senior recovery / resolutions representative
- Initiate contact with members, providers, and other insurance companies to obtain and document coordination of benefits information
- Leverage a questions - based approach to obtain information and exercise reflective listening skills to identify underlying, root cause issues
- Prioritize assigned tasks with minimal guidance from SMEs and management
- Coordinate directly with other team members to balance workload, execute priorities, and ensure assigned goals and objectives are met or exceeded
- Identify and resolve problems using defined processes, expertise, and judgment
- Communicate areas of potential improvement to SMEs for potential incorporation into processes to increase productivity, quality, and / or customer satisfaction
- Leverage problem - solving skills within established guidelines to resolve issues, questions, and conflict at the lowest level possible within the organization
- Ability to work independently and as a team with limited supervision
- Possess strong attention to detail with the ability to think in a logical and structured manner to identify problems and present solutions for consideration
- Leverage strong communication skills (verbal, non - verbal, and written) with a demonstrated ability to communicate ideas clearly and concisely with peers, superiors, members, and providers
Qualifications for senior recovery / resolutions representative
- Working Hours - business hours - 40 hours standard, OT if business needs dictate
- Intermediate level of proficiency with MS Excel required
- High School / GED or higher
- 1+ years of outbound call center experience with analyzing and solving customer problems
- Bachelor's Degree (or higher) or High School Diploma / GED and 2+ years of experience in account management / customer service
- Ability to travel 1 to 2 days a month to 2 other local sites located in Warner Robbins, GA
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Senior Recovery / Resolutions Representative Job Description
Job Description Example
Our company is growing rapidly and is hiring for a senior recovery / resolutions representative. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for senior recovery / resolutions representative
- With a focus on building a strong working rapport with the provider representatives to review and discuss over - payment situations and provide detailed explanations to the providers in both verbal and written format
- Escalate recovery efforts through many avenues to progress and resolve the situations
- Strive to meet and exceed quality production defined goals (calls / contacts), including a financial target
- Complete required documentation on all recovery efforts on a timely basis in the appropriate claims platforms
- Maintain accuracy standards of 97% or greater
- Maintain adherence standards of 95% or greater
- Account receivable follow up and resolution
- Works independently while acting as a resource and mentor for others
- Leverage a question - based approach to obtain information and exercise reflective listening skills to identify underlying, root cause issues
- Work independently while acting as a resource and mentor for others
Qualifications for senior recovery / resolutions representative
- 1+ years experience using claims platforms such as UNET, COSMOS, NICE, Facets, Diamond
- Ability to work 40 hours per week, Monday through Friday, 7 AM to 4 PM, with flexibility to overtime as needed
- Ability to work 40 hours per week, Monday through Friday, 7 AM to 4 PM, with flexibility to work overtime as needed
- Work experience with PC and Windows applications with the ability to learn new programs
- Work experience using MS Excel (editing, sorting, filtering data in spreadsheets)
- Ability to travel to other client sites within the state of Florida based on business needs
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Senior Recovery / Resolutions Representative Job Description
Job Description Example
Our growing company is hiring for a senior recovery / resolutions representative. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for senior recovery / resolutions representative
- Investigation of all assigned files to identify the presence of subrogation or right of recovery potential
- Investigation and accumulation of all relevant information required to place all parties on timely notice of Trover Solutions, inc. client’s interest
- Accumulation of proper lien amount in all assigned files through timely ordering of claims history from the client using the client specific method for doing so
- Verification and maintenance of proper lien amount through adjudication of individual bills for relatedness to the file and by duplicate bill reviews at timely intervals throughout the life of the file
- Development and monitoring of files to timely settlement by maintaining timely follow up telephone contact with all parties as appropriate including third parties, insurance adjusters and attorneys
- Completion of all settlement procedures, including settlement screens, proper documentation of settlement and follow up to insure the recovery checks are received and posted by accounting
Qualifications for senior recovery / resolutions representative
- 2+ years of experience with the Microsoft Office Suite (Word, PowerPoint, Excel, and Outlook)
- 2+ years experience analyzing and solving customer problems in an office, claims, or customer service environment
- Experience within coordination of benefits
- 1+ Medical Claims, Professional Billing, and / or Collections
- Medical healthcare terminology a plus
- Ability to travel 25% of the time locally within Macon, GA
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Senior Recovery / Resolutions Representative Job Description
Job Description Example
Our innovative and growing company is searching for experienced candidates for the position of senior recovery / resolutions representative. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for senior recovery / resolutions representative
- Experience with negotiations and direct client interactions
- 1+ years of experience in Medical Claims, Professional Billing, and / or Collections
- MS Excel experience (sorting & filtering data
- 1+ years of claims, collections, or healthcare experience
- Experience with healthcare claims
- 2+ years or account management or customer service experience
Qualifications for senior recovery / resolutions representative
- Moderate proficiency with MS Office - Excel (data entry, reporting, data analysis)
- Experience using a computer to include using email tool for business communication
- 1+ years of claims or collections experience or equivalent healthcare experience
- 1+ years of customer service with analyzing and solving customer problems
- High proficiency with computer and Windows PC applications (ability to create, copy, send and save documents, correspondence and spreadsheets in MS Word and Excel)
- Provider over - payment recovery experience
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Senior Recovery / Resolutions Representative Job Description
Job Description Example
Our growing company is hiring for a senior recovery / resolutions representative. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for senior recovery / resolutions representative
- Excellent interpersonal skills in dealing with peers, Analysts and Management
- At least 2 years experience working with subrogation Healthcare
- Required to have a dedicated work area established that is separated from other living areas and provides information privacy
- Ability to keep all company sensitive documents secure (if applicable)
- Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
- Must reside in Kansas City, Missouri
Qualifications for senior recovery / resolutions representative
- 2+ years of healthcare finance experience with a focus on auditing and / or analysis
- Ability to work in the office location one day per week
- Ability to work 40 hours and overtime if business needs dictate
- Basic proficiency in math and thinking analytically
- High School Diploma / GED (or higher) or equivalent work experience
- If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener