Claims Recovery Analyst I - Payer

Role Summary

At Trend Health Partners , a tech-enabled payment integrity company, our mission is to facilitate collaboration between payers and providers for mutual benefit and waste reduction, ultimately improving access to healthcare. We achieve this by aligning the common goals of payers and providers and fostering collaboration through a shared technology platform and seamless workflows.

Joining Trend Health Partners means becoming a part of a dynamic growing organization that promotes a collaborative and innovative work environment. Our comprehensive compensation package includes competitive salaries, highly valued health insurance, a 401(k) plan with employer match, paid parental leave, and more.

The Claims Recovery Analyst I is responsible for recovering healthcare claim overpayments identified through Trend's Payment Accuracy Services programs. This role partners with healthcare providers to facilitate accurate claim adjustments, refunds, and offsets while ensuring a positive provider experience. The analyst serves as a key contributor to recovery performance, client satisfaction, and operational excellence.

Responsibilities

• Acquireknowledgeoftheclient’sclaimsadjudicationsystem(s),memberandprovidercontracts,andclientclaimpaymentpoliciesandprocedures.
• Assistclientinidentifying,validating,andrecoveringclaimoverpayments.
• Validateclaimstoensuretheaccuracyofalgorithmsandthatnorefundhaspreviouslybeenpostedto the client’s system(s).
• Reviewandresolvedisputedoverpaymentsfromclient/provider.
• Participateinknowledgesharingtobrainstormandresolveclaimissuesorseekclarifications.
• IdentifynewoverpaymentopportunitiesandtrendsbyreviewingandresearchingareassuchasCMS and Medicaid claims processing policies, adjustments by client’s internal unit/other vendors, client’s claims processing policies/system(s), provider, and member contracts.
• Interpretandanalyzemedical andpharmacyclaimsdataaswellas providerandenrollmentdatato accurately assess and demonstrate key insights into trends and opportunities and follow concept development process.
• AssistManagementwithconceptapprovalinformationneededforclientapprovalonspecifictrends.
• Completestepbystepinstructionsforeachalgorithmmovedtoproduction.
• AlwaysrepresentTRENDandourclientsinaprofessionalmanner.
• Cooperatewithteammemberstomeetgoalsandcompletetasksinanefficientandeffectivemanner.
• ProvidefeedbacktoManagementregardinginventorylevels,algorithmeffectiveness/productivity,and new trend /ideas.
• CollaboratewithTRENDManagementtoidentifynewopportunities,areasofimprovement,and innovate potential solutions.
• Escalatetothemanageranysituationoutsidetheemployee’scontrolthatcouldadverselyimpactthe
• businessrelationship.
• Trainandassistnewanalystsasneededwhilemaintaininghighqualityandproductionresults.

Requirements

Experienceinidentification,analysis,andrecoveryofclaimoverpayments

Bachelor’sdegreeinaccounting,business,healthcare,orarelatedfield

Equivalentworkexperienceinasimilarpositionmaybesubstitutedforeducationalrequirements.

ExcellentcomputerskillsandproficientinExcel

• Strong communication and interpersonal skills, displaying the ability to connect and build relationships at all levels with payers, providers, clients, management, and peers.
• Strong analytical and problem-solving skills
• Effective organization, time management skills
• Must be able to learn, understand, and apply new technologies.
• High School Diploma or Equivalent Required

Preferred Skills

Proactive,independentandresultsoriented

Customerandteamfocused withastrongdesiretobeanactive, long-termparticipantinthegrowthof the firm overall.

• Experiencewithmedicalclaimsprocessing
• Experienceincreatingandmaintainingcomplexqueries
• Mental and Physical Demands
• Thispositionwillbeexposedmainlytoanindoorofficeenvironmentandwillbeexpectedtoworkinor around computers and printers.
• Thenatureoftheworkissedentary,andtheemployeewillbesittingmostofthetime.
• Essentialphysicalfunctionsofthejobincludetyping andtherepetitivemotiontoutilizecomputer software and hardware continuously throughout the day.
• Essentialmentalfunctionsofthispositionincludeconcentratingonanalyticaltasks,reading information,andverbal/writtencommunicationtootherscontinuouslythroughouttheday.

Related Duties as Assigned

Thisjobdescriptiondocumentsthegeneralnatureandlevelofworkbutisnotintendedtobea comprehensive list of activities, duties, or responsibilities required for this position.Consequently,employeesmaybeaskedtoperformotherdutiesasrequired.

Employees may also be asked to complete certain compliance requirements set forth by our Business Partnersintheperformanceoftheirjobsincludingbutnotlimitedtorequestsforbackgroundanddrug screenings and disclosures of personal health information or personally identifiable information. Exemptions as provided under the ADA and TITLE VII of the Civil Rights Act will be observed and followed.

Reasonableaccommodationsmaybemadetoenableindividualswithdisabilitiestoperformthe functions outlined above.