Medical Insurance Collections Specialist

Medical Insurance Collections Specialist Location: Fully Remote Schedule: Monday–Friday, 9:00 AM – 5:30 PM EST - No weekends Training Schedule: 6 weeks 9:00am-5:30pm EST Pay Rate: Starting at $18 an hour DOE- please note this rate may be below your state’s minimum wage. Consider this when applying.   Job Summary The Insurance/Collections Specialist is responsible for identifying, analyzing, and recovering overpaid medical claims from healthcare providers, third parties, and insurance carriers. This role includes resolving discrepancies related to coordination of benefits (COB), duplicate payments, and other claim errors through research, communication, and follow-up.  This position requires managing a high volume of calls, maintaining positive provider relationships, and ensuring timely resolution of accounts while meeting performance standards for collections, compliance, and productivity. Key Responsibilities - Recover medical claim overpayments through phone, email, and fax outreach  - Analyze claims data to identify overpayments and determine recovery actions  - Handle provider disputes, appeals, and complex collection scenarios  - Coordinate with clients and providers to process adjustments and reversals  - Maintain accurate follow-ups to ensure timely resolution  - Develop effective collection strategies to maximize recovery  - Communicate clearly with internal teams and external partners    Required Experience & Knowledge - Minimum 2 years of medical billing and/or insurance collections experience and account management - Strong understanding of:  - Medical claims processing and reimbursement  - Medicare (Parts A, B, C, D), Medicaid, and commercial insurance  - Coordination of Benefits (COB)  - Claim denials, appeals, and rebilling processes  - Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA)  - CPT and ICD-9/10 coding  - Healthcare settings (inpatient, outpatient, pharmacy, etc.)  - Ability to identify and explain overpayment types (duplicates, contractual, PPO, bundled claims, etc.)    Skills & Requirements - Must be able to successfully complete a background check and drug screening - Associate degree or equivalent combination of education and experience - Strong analytical, organizational, and problem-solving skills  - Excellent verbal and written communication  - Ability to manage high call volume and work independently  - Proficiency in Microsoft Office (Word, Excel, Outlook)  - Strong customer service and negotiation skills    Requirements: - Must pass an internet speed test (download equal to or greater than 25, upload equal to or greater than 5, Ping ms equal to or less than 175)   - Must have the ability to connect with an ethernet cable to a modem/router  - Live in one of the following states, AL, AR, AZ, CO CT, DE, FL, GA, ID, IN, IA, KS, KY, LA, ME, MI, MS, MO, NE, NV, NH, NJ,NM, NC, OH, OK, PA, RI, SC, SD, TN, TX,UT, VT, VA, WA, WV, WI, WY  We are currently NOT hiring in the following geographies, included but not limited to:  States: AK, CA, CT, HI, MA, IL, MT & NY  Metro Areas: MN – Minneapolis, IL – Chicago, NY – New York City, OR - Portland, MD - Montgomery County, WA - Seattle, Washington, DC   Due to varying state and local minimum wage laws, we are currently only able to hire candidates residing in states where our compensation structure complies with applicable wage regulations. As a result, we may be unable to consider applicants from certain states or municipalities at this time.   Pay Transparency Laws in some locations require disclosure of compensation and/or benefits-related information.  For this position, actual salaries will vary and may be above or below the range based on various factors including but not limited to location, experience, and performance. In addition to base pay, this position, based on business need, may be eligible for a bonus or incentive. In addition, Conduent provides a variety of benefits to employees including health insurance coverage, voluntary dental and vision programs, life and disability insurance, a retirement savings plan, paid holidays, and paid time off (PTO) or vacation and/or sick time. The estimated hourly rate is $18.00. About Company Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law. For US applicants: People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by submitting their request through this form that must be downloaded:  click here to access or download the form.  Complete the form and then email it as an attachment to [email protected]. You may also click here to access Conduent's ADAAA Accommodation Policy. Company Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.