[Hiring] Lead, Medicare Payments Recovery @CAQH

Role Description

This role supports a highly specialized Medicare Secondary Payer (MSP) recovery function focused on identifying and resolving incorrect CMS/Medicare payment cases. This role performs detailed, manual case review to validate coverage responsibility, identify overpayments, and drive recovery efforts with impacted plans. Due to CMS data access and extraction limitations, the work is highly analytical and manual in nature, requiring strong judgment, documentation rigor, and deep familiarity with benefits coordination and claims recovery processes.

Qualifications

• Strong analytical skills with the ability to perform detailed, manual case review
• Claims and billing data analysis
• Revenue tracking and reporting
• Process documentation and workflow design
• Stakeholder coordination and client communication
• High attention to detail
• Ability to track, report, and reconcile member and revenue data
• Strong written communication and documentation skills

Requirements

• Experience producing structured, auditable documentation and reports
• Experience working in healthcare data, revenue operations, or regulatory validation environments
• Demonstrated experience working with complex eligibility, coverage, and payment data
• Comfort working in highly governed environments and familiarity with healthcare compliance and audit standards
• Experience in Medicare Secondary Payer (MSP), payment integrity, benefits coordination, or claims recovery
• Experience with CMS data, Medicare recovery processes, or healthcare overpayment recovery
• Background in payment integrity, revenue recovery, or benefits administration

Benefits

• Competitive compensation
• Comprehensive benefits package for full-time employees
• Medical, dental, and vision coverage
• 401(k) with company contributions and matching
• Paid parental leave
• Tuition assistance
• Generous paid time off
• Commitment to investing in our people and supporting professional growth over time