Refund Specialist

Allied Benefit Systems•Chicago, IL

22h•$20 - $22•Remote

About The Position

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.

Requirements

Bachelors degree or equivalent work experience required.
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

Responsibilities

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