Claims Recovery Analyst I - Payer

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Claims Recovery Analyst I - Payer based in the United States.

This role supports healthcare payment accuracy by identifying and recovering claim overpayments for payer clients.
You’ll work at the intersection of healthcare claims, data analysis, provider relationships, and payment integrity.
The position involves validating claims, researching payment policies, resolving disputes, and identifying emerging recovery opportunities.
You’ll analyze medical, pharmacy, provider, and enrollment data to uncover trends and translate findings into actionable insights.
Success in the role requires close collaboration with clients, providers, management, and fellow analysts while maintaining a high standard of accuracy.
You’ll also contribute to improving recovery processes, developing new opportunities, and supporting the effectiveness of payment accuracy programs.
This is a strong opportunity for an analytical, organized professional who wants to build expertise in healthcare claims and contribute to reducing waste across the healthcare system.

Accountabilities

• Learn and apply client-specific claims adjudication systems, member and provider contracts, payment policies, and operational procedures.
• Support the identification, validation, and recovery of healthcare claim overpayments.
• Review claims to verify the accuracy of recovery algorithms and confirm that refunds or adjustments have not already been processed.
• Investigate and resolve disputed overpayments involving clients and healthcare providers while maintaining a professional and constructive relationship.
• Research CMS, Medicaid, provider, member, and client-specific policies to identify new overpayment opportunities and emerging trends.
• Analyze medical and pharmacy claims, provider information, and enrollment data to identify patterns, opportunities, and meaningful insights.
• Support the development and approval of new recovery concepts by preparing relevant information and analysis for management and clients.
• Create and maintain detailed step-by-step documentation for algorithms and processes moved into production.
• Monitor inventory levels, algorithm effectiveness, productivity, and recovery opportunities, providing relevant feedback to management.
• Collaborate with colleagues and leadership to identify process improvements, new opportunities, and innovative solutions.
• Escalate situations that could negatively affect client or provider relationships and help ensure timely resolution.
• Contribute to team goals by completing work efficiently, accurately, and within established quality and production expectations.
• Support the onboarding and development of new analysts when needed while maintaining strong individual performance.
• Represent the organization and its clients professionally in all interactions and communications.

Requirements

• Experience identifying, analyzing, and recovering healthcare claim overpayments is preferred.
• Bachelor’s degree in accounting, business, healthcare, or a related field; equivalent relevant work experience may substitute for educational requirements.
• High school diploma or equivalent is required.
• Strong computer skills and proficiency with Microsoft Excel.
• Strong analytical and problem-solving abilities, with the capacity to interpret complex claims and payment information.
• Excellent written, verbal, and interpersonal communication skills, with the ability to build effective relationships with payers, providers, clients, management, and colleagues.
• Strong organizational and time-management skills, with the ability to manage multiple priorities and meet productivity and quality expectations.
• Ability and willingness to learn, understand, and apply new technologies, systems, and processes.
• Proactive, independent, and results-oriented approach to work.
• Customer- and team-focused mindset, with a genuine interest in contributing to long-term organizational growth.
• Experience with medical claims processing is a plus.
• Experience creating and maintaining complex queries is preferred.
• Ability to concentrate on detailed analytical work, interpret information accurately, and communicate findings effectively in a computer-intensive environment.

Benefits

• Salary: $50,000–$60,000 USD per year.
• Remote work environment.
• Health insurance benefits.
• 401(k) plan with employer match.
• Paid parental leave.
• Collaborative and innovative work environment.
• Opportunity to develop expertise in healthcare claims, payment integrity, analytics, and recovery operations.
• Exposure to payer-provider relationships, claims systems, healthcare policies, and data-driven payment accuracy programs.
• Opportunities to contribute to process improvements, new recovery concepts, and operational innovation.
• Reasonable accommodations are available for qualified individuals with disabilities.

How Jobgether works:

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

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We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.