• Acquire knowledge of the client’s claims adjudication system(s), member and provider contracts, and client claim payment policies and procedures. • Assist client in identifying, validating, and recovering claim overpayments. • Validate claims to ensure the accuracy of algorithms and that no refund has previously been posted to the client’s system(s) • Review and resolve disputed overpayments from client/provider. • Participate in knowledge sharing to brainstorm & resolve claim issues or seek clarifications. • Identify new overpayment opportunities by reviewing and researching areas such as CMS and Medicaid claims processing policies, adjustments by client’s internal unit/other vendors, client’s claims processing policies/system(s), provider, and member contracts. • Ideate, test, document & submit new overpayment trends/research scenarios. • Research potential new ideas and follow algorithm development process. • Assist Management with concept approval information needed for client approval on specific trends. • Always represent TREND and our clients in a professional manner • Cooperate with team members to meet goals and complete tasks in an efficient and effective manner. • Provide feedback to Management regarding inventory levels, algorithm effectiveness/productivity and new trend /ideas. • Collaborate with TREND Management to identify new opportunities, areas of improvement and innovate potential solutions. • Escalate to the manager any situation outside the employee’s control that could adversely impact the business relationship.