[Hiring] Senior Refund Specialist @Allied Benefit Systems

Role Description

The Senior Refund Specialist will review, analyze, and make determinations regarding solicited refunds based upon specific claim guidelines and plan benefits. Prepare and track overpayments from providers for solicited refunds.

Essential Functions

• Review and evaluate refund requests associated with claims for accuracy, eligibility, and compliance
• Investigate discrepancies in claims, payments, and billing to determine appropriate refund actions
• Process refunds in accordance with company policies, contractual obligations, and regulatory requirements
• Contact providers for status updates on refund request
• Collaborate with internal teams (e.g., billing, finance, customer service, provider relations) to resolve complex cases
• Read, analyze, understand, and ensure refunds are handled in compliance with clients’ Summary Plan Descriptions
• Prepare and track overpayment request letters to providers
• Review, analyze and add applicable notes to the overpayment log
• Assist and support team members as needed and when requested
• Other duties as assigned

Qualifications

• High school diploma or equivalent required
• Minimum 3 years of equivalent work experience required
• Strong analytical skills and knowledge of computer systems
• Knowledge in CPT and ICD-10 coding terminology
• Claims recovery experience preferred
• Proficient in the use of the Excel and Word programs
• Strong written and verbal communication skills required

Requirements

• Accountability
• Communication
• Customer Service Orientation
• Functional/Technical Skills
• Quality Focus
• Time and Task Management

Physical Demands

This is a standard desk role requiring extended periods of sitting and computer work.

Work Environment

Remote

Benefits

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