<p>Claims Financial & Recovery Adjustment Specialist</p> <p>SummaCare - 1200 E Market St, Akron, OH</p> <p>Full-Time / 40 Hours / Days</p> <ul> <li>Hybrid after training </li></ul> <p>As a regional, provider-owned health plan, SummaCare values the relationship between the members and their doctors. SummaCare is a part of Summa Health, an integrated healthcare delivery system that includes Summa Health System hospitals, its community-based health centers, dedicated clinicians and SummaCare. Based in Akron, Ohio, SummaCare provides Medicare Advantage, individual and family and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2025 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits.</p> <p>Summary:</p> <p>Performs the necessary tasks to ensure payment accuracy and coordinates recoveries of health insurance claims both internal and external. Maintains accurate documentation and reporting.</p> <p>Formal Education Required:</p> <ul> <li>High School Diploma or equivalent. </li></ul> <p>Experience & Training Required:</p> <ul> <li>Two (2) years progressively responsible experience to include health insurance claim processing; general accounting, posting and/or billing; and claims analysis and reporting. </li></ul> <p>Other Skills, Competencies and Qualifications:</p> <ul> <li>Word, Excel and Access at a basic level, MS-windows based computer environment. Must achieve passing score on test administered by Human Resources. </li><li>Medical terminology, CPT, HCPC's and ICD-10 coding. </li><li>Understanding of unique benefits and processing rules for self-funded, Medicare, MEWA, Marketplace and fully-insured plans. </li><li>Understanding professional (CMS1500) and institutional (UB04) claim types. </li><li>Independent judgment and decision-making skills </li></ul> <p>Level of Physical Demands:</p> <ul> <li>Sit for prolonged periods of time. </li><li>Bend, stoop and stretch. </li><li>Lift up to 20 pounds. </li><li>Manual dexterity to operate computer, phone and standard office machines. </li></ul> <p>Equal Opportunity Employer/Veterans/Disabled</p> <p>$21.54/hr - $25.86/hr</p> <p>The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical.</p> <p>Summa Health offers a competitive and comprehensive benefits program to include medical, dental, vision, life, paid time off as well as many other benefits.</p> <ul> <li>Basic Life and Accidental Death & Dismemberment (AD&D) </li><li>Supplemental Life and AD&D </li><li>Dependent Life Insurance </li><li>Short-Term and Long-Term Disability </li><li>Accident Insurance, Hospital Indemnity, and Critical Illness </li><li>Retirement Savings Plan </li><li>Flexible Spending Accounts - Healthcare and Dependent Care </li><li>Employee Assistance Program (EAP) </li><li>Identity Theft Protection </li><li>Pet Insurance </li><li>Education Assistance </li><li>Daily Pay </li></ul>