Participate in claims workflow projects.
Responds to telephone and written inquiries and initiates steps to assist callers regarding issues relating to the content or interpretation of benefits, policies and procedures, provider contracts, and adjudication of claims.
Adjusts voids and reopens claims on-line within guidelines to ensure proper adjudication.
May have customer/client contact.
May assist with training of staff.
Works without significant guidance.

Requires a HS diploma and a minimum of 3 years of the companies internal claims experience; or any combination of education and experience which would provide an equivalent background.
Government claim processing experience STRONGLY preferred.
TS Home and/or Host experience preferred
Claim Adjustment experience preferred
Demonstrated ability to work independently, prioritize workload, and take ownership of daily deliverables with minimal supervision.
Strong ability to read, interpret, and accurately apply documented policies, procedures, and processing steps to ensure compliant, consistent outcomes.
Flexibility to shift between work types (e.g., queues, outreach, research, corrections) and adapt quickly to changing priorities while maintaining production and quality standards.
High attention to detail and accuracy when reviewing financial information, resolving discrepancies, and documenting actions in required systems.
Effective time management and organization skills to meet deadlines and service-level expectations in a high-volume environment.

Financial Operations Recovery Specialist I

Key skills