Senior Refund Specialist

Allied Benefit Systems•Chicago, IL

1d•$20 - $21•Remote

About The Position

The Senior Refund Specialist reviews, analyzes, and makes determinations regarding solicited refunds based on claim guidelines and plan benefits. The role prepares and tracks provider overpayments and refund requests, ensuring they comply with client Summary Plan Descriptions, company policies, contractual obligations, and regulatory requirements. This is a remote, full-time position requiring a cable broadband or fiber-optic internet connection with minimum speeds of 100 Mbps download and 25 Mbps upload.

Requirements

High school diploma or equivalent.
At least 3 years of equivalent work experience.
Strong analytical skills and knowledge of computer systems.
Knowledge of CPT and ICD-10 coding terminology.
Proficiency with Microsoft Excel and Word.
Strong written and verbal communication skills.
Cable broadband or fiber-optic internet service with speeds of at least 100 Mbps download and 25 Mbps upload.

Nice To Haves

Claims recovery experience.

Responsibilities

Review and evaluate claim-related refund requests 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 updates on refund requests.
Collaborate with internal teams, including billing, finance, customer service, and provider relations, to resolve complex cases.
Ensure refunds are handled in compliance with clients’ Summary Plan Descriptions.
Prepare and track overpayment request letters to providers.
Review and analyze overpayment information and add applicable notes to the overpayment log.
Assist and support team members as needed and when requested.
Perform other duties as assigned.