Payment & Refund Control Specialist I

Arkansas Blue Cross • Little Rock, AR

7d • Onsite

About The Position

The Payment & Refund Control Specialist is responsible for daily validation of multiple claims payment cycles, which includes accurate, efficient and timely end-to-end processing of claims refunds and stop payment requests. The payment activities include, but are not limited to, timely balancing and verifying payment data (daily and monthly adjudication controls to check register), evaluating the results of claim adjustment transaction on payments, assisting with problem resolution with the appropriate information systems staff, and communication of same to various operational areas.

Requirements

• High School diploma or equivalent.
• Minimum one (1) year recent bookkeeping or account receivable experience.
• Microsoft Excel experience required.
• Proficiency using computer applications, which includes spreadsheets, word processing, and database applications.
• Ability to Work Independently or as a Team.

Nice To Haves

• Claims processing or claims adjustment experience preferred.

Responsibilities

• Assists in other duties, as assigned
• Coordinates the overpayment correspondence function, which includes the creation and delivery of Check Control memos in a timely manner. Initiates systematic releases of payment materials to print and mail operations.
• Interprets and adheres to all regulations and policies related to overpayments to ensure compliance. This may vary depending on reason, type of claim overpayment and line of business.
• Maintains awareness of corporate fiscal policy and fiscal administration guidelines and the impact on financial reporting of the Enterprise.
• Performs daily validation of multiple claims payment cycles, which includes accurate, efficient and timely end-to-end processing of claims refunds and stop payment requests in accordance to corporate policies, audit requirements, and operational procedures and standards. Checks returned by providers or members and undeliverable checks must be controlled and disposed timely.
• Works closely with Claims and Customer Service Operations, providers, and occasionally members to resolve problems and respond to inquiries regarding payments and refunds.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 501-1,000 employees