Healthcare Reclamation Analyst

About the role

Hiring Range: $20 - $26/hr. The Healthcare Reclamation Analyst reviews assigned client data and payer correspondence, investigates coverage to determine eligibility and primacy, and gathers and interprets explanation of benefits and payer feedback in order to recover funds for clients who have paid in error.

Responsibilities

• Leverage solid knowledge and expertise in COB/TPL/Recovery to gather and review in-house data with payer correspondence to determine proper order of benefits and resolve primacy issues.
• Successfully solves data or record discrepancies and/or issues.
• Leverage your knowledge and expertise in COB/TPL/MSP to review documentation and eligibility, investigate the file to determine proper order of benefits and answer questions and/or provide information that will bring to successful payment or other appropriate account action.
• Communicate effectively with carriers to determine primacy; answer questions and/or provide information that will bring to successful payment or other appropriate account action.
• Contact Healthcare Insurance carriers regarding claim responses.
• Educate Healthcare Insurance carriers on the Coordination of Benefits rules and appropriately responds to complex questions.
• Analyze and understand written communication from insurance companies including explanation of benefits (EOBs).
• Support internal groups or functions with gathering and interpretation of the claims billing process and denial management.
• Effectively follow and contribute to continuous improvement of scripts, guidelines and other tools provided to have professional conversations with Healthcare Insurance carriers, and/or providers
• Efficiently and diligently work through assigned inventories to consistently meet productivity metrics assigned by management.
• Leverage knowledge and expertise to research various scenarios that will bring to successful resolution and payment (i.e.. eligibility research and claims appeals).
• Initiate applicable action and documentation based upon insurance carriers selected.
• Update company systems with clear and accurate information such as point of contact, updated demographic information, notes from contact from outbound and inbound calls and/or attempts, as well as account status updates as applicable
• Arrives to work on-time, works assigned schedule, and maintains regular good attendance.
• Follows and complies with company, departmental and client program policies, processes, and procedures.
• Follows and complies with company, departmental and client program policies, processes, and procedures.
• Responsible for utilizing resources to ensure compliance with client requirements, HIPAA, as well as applicable federal or state regulations.
• Successfully completes, retains, applies, and adheres to content in required training as assigned.
• Consistently achieve or exceed established metrics and goals assigned, including but not limited to, production and quality.
• Demonstrates Performant core values in performance of job duties and all interactions.
• Correct areas of deficiency and oversight received from quality reviews and/or management.
• Work overtime as may be required.
• Performs other duties as assigned.
• Knowledge, Skills and Abilities Needed
• Demonstrated solid applied knowledge and experience with Healthcare, medical terminology, and medical coding, preferably in roles generating, auditing, recovery and/or researching the same.
• Demonstrated relevant depth of skills and experience with Coordination of Benefits, Third Party Liability, and Accounts Receivable.
• Good research and investigative skills with proven ability to gather and interpret Explanation of Benefits (EOB) to answer questions and consistently resolve primacy issues.
• Ability to communicate professionally and effectively with providers, carriers and other audiences regarding eligibility and/or Coordination of Benefits (COB).
• Proven ability to gather and interpret Explanation of Benefits (EOB) and answer questions and resolve issues with payments.
• Protected patients' privacy, und

Benefits

Additional Information

ABOUT MACHINIFY: In October 2025, Machinify acquired Performant and we are now part of the Machinify organization. Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify's AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy. We're reshaping healthcare payment through seamless intelligence.

Your Match

How well this role fits your profile.

Company Intel

What employees say

Worked at performant? Share your experience