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Claims Recovery Team Lead

Date:  Jun 16, 2022

Any city, TX, US, 99999

Req ID:  10749

We are seeking a talented individual for a Claims Recovery Team Lead who is responsible for leading an assigned team in recovering payments from commercial insurance carriers who should have paid primary to the Medicaid agency.


Essential Responsibilities

Lead and coach a team of claims recovery collectors to make contact with carriers and providers in order to drive document and payments recoveries on behalf of our clients

  • Act as the initial point of contact to, and be the subject matter expert for a team of Operations agents.
  • Train and mentor team members to improve and maintain high-levels of production
  • Perform regular quality checks based on metrics and performance data
  • Create and maintain training documentation and department job-aids
  • Handle escalated calls from more junior team members.
  • Act as back up for supervisor as needed.
  • Confer with carriers by telephone or use Web sites to determine member eligibility and claim status.
  • Assess denials, pursue appeals or close claims when appropriate.
  • Update case management system with proper noting of actions and appeal/denial information.
  • Respond to carrier telephone, fax and e-mail inquiries regarding outstanding claims.
  • Sort and file correspondence.
  • Mail form letters to carriers to affect payment of outstanding claims
  • Contact providers to obtain additional information and/or documentation to resolve unpaid claims
  • Responsible for achieving high recoveries against a portfolio of claims
  • Work with document imaging system for processing purposes
  • Ensure that payers adhere to laws regarding timely filing of claims
  • Pursue each outstanding account to reach maximum reimbursement by working with subject matter experts to resolve challenging claims
  • Required to meet more stringent fiscal and daily work event goals
  • Query databases to ensure inventory is prioritized correctly
  • Run SQL to generate basic reports
  • Report on team functions, quality, and throughput metrics


Minimum Related Work Experience

  • 5-7 yrs. experience with third party collections
  • 3 yrs experience handling appeals claims in hospital setting
  • Ability to interpret an Explanation of 
  • Benefits (EOB) and UB-04 claim form required. DSM-IV, CPT, HCPCS, and CMS-1500 preferred
  • Working knowledge of Access and SQL also preferred.

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