Hiring: Cost Avoidance Specialist I Company: Partnership HealthPlan of California Location: Fairfield, CA Job Posted Time: 2026-09-03 07:38:56 About the job Required Skills: •Assess, implement, and monitor activities related to recoveries and cost savings of medical claims with duties including but not limited to: •Perform assessments and identify potential overpayments on claims related to all lines of business •Research and identify overpayments related to over utilization of procedures, billing procedures, potential fraudulent claims, duplicate payments, and overpayments due to lack of coordination of benefits with member's primary health care insurance policy such as a private health insurance, Medicare coverage, or an open case with CCS •Perform recovery activities associated with claim audit findings •Report dollar amounts identified for recovery, recovery amounts received, and reasons for overpayments •Lead and oversee identifying via reports, Medi-Cal overpayments due to retro-active Medicare or Third Party coverage and the recoupment of same. •Research and process all Partnership product lines for COB and Third Party Liability (TPL) recoveries and communicate outcome with Cost Avoidance Supervisor. •Prepare r eports as per requirements of Department of Health Care Services (DHCS) and other regulatory or auditing agencies for Cost Avoidance Supervisor review. Qualifications: •Special Skills, Licenses and Interested candidates, please apply directly through the job posting on company's career page or try via AI auto apply on this platform. Don't miss this opportunity to join a forward-thinking team!