At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.
Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there's no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you'll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.
The ideal candidate will live within driving distance of the Omaha, Nebraska office. This position allows remote flexibility but may have in-office collaboration and meetings.
If living in one of our approved states (Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and Texas) - this person may travel to our headquarters.
This position is responsible for reviewing and researching all findings from our Payment Integrity (PI) vendors and driving awareness to mitigate future claim overpayments. The individual will reconcile PI vendor monthly billing by maintaining accurate records of all PI vendor accounts, investigate new data mining overpayment concepts for our internal PI team, and recover overpayments that cannot be offset by providers and/or members via outreach communications. In addition, this person will be responsible for quantifying and validating prepay and post pay claims for BCBSA InterPlan and will invoice for vendor fees of PI activities BCBSNE performs for other host Blues Plans.
What you'll do:
Payment Integrity Data Mining/Recovery Specialist • United States
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