[Hiring] Medical Insurance Collections Specialist @Conduent Payment Integrity Solution Inc.

Role Description

The Insurance/Collections Specialist is responsible for identifying, analyzing, and recovering overpaid medical claims from healthcare providers, third parties, and insurance carriers. This role includes resolving discrepancies related to coordination of benefits (COB), duplicate payments, and other claim errors through research, communication, and follow-up.

This position requires managing a high volume of calls, maintaining positive provider relationships, and ensuring timely resolution of accounts while meeting performance standards for collections, compliance, and productivity.

Key Responsibilities

• Recover medical claim overpayments through phone, email, and fax outreach
• Analyze claims data to identify overpayments and determine recovery actions
• Handle provider disputes, appeals, and complex collection scenarios
• Coordinate with clients and providers to process adjustments and reversals
• Maintain accurate follow-ups to ensure timely resolution
• Develop effective collection strategies to maximize recovery
• Communicate clearly with internal teams and external partners

Qualifications

• Minimum 2 years of medical billing and/or insurance collections experience and account management
• Strong understanding of:
  • Medical claims processing and reimbursement
  • Medicare (Parts A, B, C, D), Medicaid, and commercial insurance
  • Coordination of Benefits (COB)
  • Claim denials, appeals, and rebilling processes
  • Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA)
  • CPT and ICD-9/10 coding
  • Healthcare settings (inpatient, outpatient, pharmacy, etc.)
  • Ability to identify and explain overpayment types (duplicates, contractual, PPO, bundled claims, etc.)

Requirements

• Must be able to successfully complete a background check and drug screening
• Associate degree or equivalent combination of education and experience
• Strong analytical, organizational, and problem-solving skills
• Excellent verbal and written communication
• Ability to manage high call volume and work independently
• Proficiency in Microsoft Office (Word, Excel, Outlook)
• Strong customer service and negotiation skills
• Must pass an internet speed test (download equal to or greater than 25, upload equal to or greater than 5, Ping ms equal to or less than 175)
• Must have the ability to connect with an ethernet cable to a modem/router
• Live in one of the following states: AL, AR, AZ, CO, CT, DE, FL, GA, ID, IN, IA, KS, KY, LA, ME, MI, MS, MO, NE, NV, NH, NJ, NM, NC, OH, OK, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY

Benefits

• Health insurance coverage
• Voluntary dental and vision programs
• Life and disability insurance
• Retirement savings plan
• Paid holidays
• Paid time off (PTO) or vacation and/or sick time