Recovery Analyst

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 role 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.