Payment & Refund Control Specialist I

Arkansas Blue Cross and Blue Shield; Little Rock (AR); Remote; USD 80,000 - 175,000; Full time

Job summary

A leading insurance company is seeking a Payment & Refund Control Specialist responsible for managing and validating claims payment cycles. The ideal candidate will have experience in bookkeeping and a strong grasp of Microsoft Excel. This entry-level full-time position requires attention to detail, problem-solving skills, and the ability to work both independently and collaboratively.

Qualifications

• Minimum one year recent bookkeeping or account receivable experience required.
• Claims processing or claims adjustment experience preferred.
• Proficiency in Microsoft Excel and Office Suites necessary.

Responsibilities

• Daily validation of claims payment cycles and processing of claims refunds.
• Coordinate overpayment correspondence and ensure compliance with corporate policies.
• Work closely with Claims and Customer Service Operations to resolve payment issues.

Skills

Account Receivable

Multitasking

Logical Thinking

Mathematics

Problem Solving

Customer Service

Oral & Written Communication

Strong Interpersonal Communication

Confidentiality

Detail Oriented

Education

High School diploma or equivalent

Tools

Microsoft Excel

Microsoft Office Suites

Job description

4 days ago Be among the first 25 applicants

To learn more about Arkansas Blue Cross and Blue Shield Hiring Policies, please click here.
Applicants must be eligible to begin work on the date of hire. Applicants must be currently authorized to work in the United States on a full-time basis. ARKANSAS BLUE CROSS BLUE SHIELD will NOT sponsor applicants for work visas in this position.
Arkansas Blue Cross is only seeking applicants for remote positions from the following states:

Arkansas, Florida, Georgia, Illinois, Kansas, Louisiana, Minnesota, Mississippi, Oklahoma, South Carolina, Tennessee, Texas, Virginia and Wisconsin.

Job Summary

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


EDUCATION
High School diploma or equivalent.

Experience

Minimum one (1) year recent bookkeeping or account receivable experience.

Microsoft Excel Experience Required.

Claims processing or claims adjustment experience preferred.

• This is a full-time in-office position**
  
  
  

Essential Skills & Abilities

Account Receivable
Multitasking
Logical Thinking
Mathematics
Problem Solving
Customer Service
Oral & Written Communication
Strong Interpersonal Communication
Analyze Information
Professional Judgment
Highly Organized
Detail Oriented
Time Management
Confidentiality
Highly Motivated Self-Starter
Microsoft Office Suites including Excel & Word
Proficiency using computer applications, which includes spreadsheets, word processing, and database applications.
Ability to Work Independently or as a Team.

Skills

• Analyze Information
• Confidentiality
• Customer Service
• Detail-Oriented
• Group Problem Solving
• Logical Thinking
• Mathematics
• Multitasking
• Professional Judgment
• Self-Starter
• Time Management
• Written Communication
  
  
  

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.
  
  

Certifications
Security Requirements
This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.
Segregation of Duties
Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.
Employment Type
Regular

ADA Requirements

1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Accounting/Auditing and Finance

• Industries

  Insurance

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