[Hiring] Refund Specialist @Allied Benefit Systems

Role Description

The Refund Analyst will use independent judgement and discretion to review, analyze, and make determinations regarding solicited and unsolicited refunds based upon specific claim guidelines and plan benefits.

• Prepare and track overpayments to providers for solicited refunds
• Assist with specific tasks and projects as needed and assigned by the Management Team
• Independently review, analyze, and make determinations of refunds
• Read, analyze, understand, and ensure refunds are handled in compliance with clients’ Summary Plan Descriptions
• Consult with other departments including Reinsurance, Accounting, and Claims as needed to determine the appropriateness of refunds and ensure the refund is applied accurately
• Process, adjust, and void claims in the QicLink system
• Prepare and track overpayment request letters to providers
• Contact providers for status updates on refund request
• Review and analyze daily, weekly, and monthly reports from accounting department(s) to either void, adjust, or apply a refund in the QicLink System
• Review, analyze and add applicable notes to the QicLink System and Access database
• Assist and support team members as needed and when requested
• Monitor and track refunds in the Access database
• Participate in continuing education in all areas affecting group health and welfare plans
• Perform other duties and responsibilities as assigned

Qualifications

• Bachelor's degree or equivalent work experience required

Requirements

• Minimum of 5 years of medical claims analysis and adjudication experience (including dental, vision, and HRA claims), preferably on the QicLink claims processing system required
• Strong analytical skills and knowledge of computer systems
• Knowledge in CPT and ICD-10 coding terminology
• Proficient in the use of the Excel and Word programs, have experience with or ability to learn Microsoft Access
• Strong written and verbal communication skills required

Benefits

• Medical, Dental, Vision, Life & Disability Insurance
• Generous Paid Time Off
• Tuition Reimbursement
• EAP
• Technology Stipend

Work Environment

This is a standard desk role – long periods of sitting and working on a computer are required.

Remote work is supported with a requirement for a reliable internet connection through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload.