Job Overview
Location
Work at Home - Nebraska
Job Type
Full-time
Category
Operations
Date Posted
March 27, 2026
Full Job Description
đź“‹ Description
- • As a Payment Integrity Data Mining/Recovery Specialist at Nebraska Blue Cross and Blue Shield, you will play a critical role in safeguarding the financial integrity of healthcare claims by identifying, investigating, and recovering overpayments, directly contributing to cost containment and member trust in a mission-driven organization dedicated to improving community health.
- • You will work remotely with the flexibility to collaborate in-person when needed, supporting a vital function that ensures accurate claims processing, reduces waste, and strengthens the company’s ability to deliver affordable, high-quality care to Nebraskans and beyond.
- • Day to day, you will analyze vendor-submitted payment integrity findings, reconcile billing records, and validate overpayment identifications to ensure accuracy and prevent duplicate recoveries.
- • You will investigate discrepancies between vendor-flagged overpayments and actual claim adjustments, routing approved amounts to appropriate teams while documenting unresolved issues for further review.
- • You will audit internal data mining models and concepts to uncover new overpayment patterns, then conduct targeted outreach to providers and members to secure manual refunds where automated recovery is not possible.
- • You will validate prepay and post-pay payment integrity activities on Host Blues Plan claims, compile and reconcile data for invoicing, and coordinate with BlueCard claims operations and finance teams to ensure timely and accurate vendor fee billing.
- • You will respond to internal inquiries about overpayment trends and refund activity, document recovery procedures, and support special projects and audit requests as needed.
- • You will maintain organized, auditable files of all payment integrity vendor accounts and activities, ensuring compliance, traceability, and readiness for internal or external reviews.
- • You will partner with cross-functional teams including claims, finance, and vendor management to drive process improvements and share insights that mitigate future overpayment risks.
- • You will contribute to a culture of accountability and continuous improvement by helping refine recovery strategies and sharing lessons learned from complex overpayment cases.
- • You will gain deep expertise in healthcare payment integrity, claims adjudication, data analysis, and regulatory compliance within a leading regional health plan, building transferable skills in analytics, investigation, and stakeholder communication.
- • You will develop proficiency in interpreting complex claims data, navigating BlueCard and InterPlan systems, and understanding payer-provider dynamics—positioning you for advancement in healthcare operations, finance, or compliance roles.
🎯 Requirements
- • High School Diploma or equivalent and two (2) years of experience in a health insurance field.
- • One (1) year of refund, Payment Integrity, and/or auditing experience (preferred but not required).
- • Ability to work well in a team environment and build positive relationships with staff, departments, and external partners.
- • Strong attention to detail and ability to perform each essential duty satisfactorily, including accurate data reconciliation and documentation.
- • Ability to meet attendance and timeliness requirements of the department.
- • Willingness to live within driving distance of the Omaha, Nebraska office for occasional in-person collaboration, with remote flexibility otherwise.
🏖️ Benefits
- • Remote work flexibility with the option to collaborate in-person at the Omaha headquarters when needed.
- • Opportunity to work for a mission-driven, nonprofit health plan committed to improving the health and well-being of Nebraskans and surrounding communities.
- • Access to professional development and career growth opportunities within a stable, reputable organization with a strong internal promotion culture.
- • Comprehensive benefits package typical of a major regional health insurer (health, dental, vision, retirement, paid time off).
- • Exposure to complex healthcare payment systems, data mining techniques, and cross-functional projects that build valuable, transferable expertise in healthcare operations and finance.
Skills & Technologies
Remote
About Nebraska Blue Cross and Blue Shield
Nebraska Blue Cross and Blue Shield is a member-owned nonprofit health insurer headquartered in Omaha, providing medical, dental, vision, pharmacy, and supplemental coverage to individuals, families, and employers statewide. Founded in 1939, the company administers self-funded plans, Medicare Advantage, and Medicaid products, operating a statewide provider network of hospitals, physicians, and specialists. It also offers health-management programs, wellness incentives, and digital tools to improve care quality and affordability for more than 750,000 members.
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