Refund Specialist

POSITION SUMMARY
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.

ESSENTIAL FUNCTIONS

• 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

EDUCATION

• Bachelors degree or equivalent work experience required.

EXPERIENCE & SKILLS

• 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

COMPETENCIES

• Communication
• Customer Focus
• Accountability
• Functional/Technical Job Skills

PHYSICAL DEMANDS

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

WORK ENVIRONMENT

• Remote

Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.

The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

Compensation is not limited to base salary.  Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life & Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.

Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time.  All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process.  It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.