We exist for workers and their employers -- who are the backbone of our economy. That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills.
The Recovery Analyst is primarily responsible for managing all file requirements from beginning to end for subrogation cases, No Surprises Act (NSA) disputes, and overpayment recoveries with the assigned third-party vendor. This includes researching paid claims, answering inquiries, coordinating with other departments, and adjusting claims based on overpayments of claims and settlements for both the subrogation and NSA processes. This individual will work as an effective interface between internal and external customers and maintain good member and partner relationships.
Responsibilities Include:
Prepare documentation, review claim history, and other documentation related to overpayment, subrogation, and NSA requests.
Utilize available resources to investigate claim situations for overpayment, subrogation, and NSA cases.
Follow-up with responsible departments and delegated entities to ensure compliance.
Monitors daily and weekly inventory to ensure internal and regulatory timeframes are met.
Identify areas of potential improvement and provide feedback and recommendations to management on issue resolution, quality improvement, network contracting, policies and procedures, administrative costs, cost-saving opportunities, best practices, and performance issues.
Notifies the assigned vendors and clients of the subrogation and recovery interest; confers with other parties, internal departments, and clients concerning potential settlement or other actions.
Represents Centivo in meetings concerning recovery, subrogation, and NSA matters, including facilitating calls between Centivo’s third-party vendor and the client, to obtain final approval.
Maintain data entry requirements for all complaints and appeals.
Perform any other additional tasks or duties as assigned or required.
Qualifications:
Required Skills and Abilities:
Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others.
Must possess proven organizational, rational reasoning, ability to examine information, and problem-solving skills, with attention to detail necessary to act within complex environment.
Knowledge of applicable rules and statutes, of the process and principles of insurance and of basic subrogation and NSA concepts.
Ability to comprehend and produce grammatically accurate, error-free business correspondence required.
Ability to appropriately identify urgent situations and follow the appropriate protocol.
Requires the ability to plan, manage multiple priorities, and deliver complete, accurate, and timely results in a fast-paced office environment.
Education and Experience:
High School diploma or equivalent required, Associate degree preferred.
At least one year of experience in health plan operations, claims processing, subrogation, or other experience directly related to position duties and knowledge.
Additional years of experience/training may be considered in lieu of educational requirements required.
Preferred Qualifications:
Prior subrogation or NSA experience.
Work Location:
Candidates located within commuting distance of our Buffalo office will be considered for both in-person and hybrid roles. All other applicants will be considered for remote positions.
Who we are:
Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Anchored around a primary care based ACO model, Centivo saves employers 15 to 30 percent compared to traditional insurance carriers. Employees also realize significant savings through our free primary care (including virtual), predictable copay and no-deductible benefit plan design. Centivo works with employers ranging in size from 51 employees to Fortune 500 companies. For more information, visit centivo.com.
Headquartered in Buffalo, NY with offices in New York City and Buffalo, Centivo is backed by leading healthcare and technology investors, including a recent round of investment from Morgan Health, a business unit of JPMorgan Chase & Co.
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