Senior Refund Specialist

Allied Benefit Systems; Chicago (IL); Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Remote work

Technology stipend

Job summary

Allied Benefit Systems is seeking a Senior Refund Specialist to review, analyze, and determine solicited refunds based on specific claim guidelines and plan benefits. The role involves preparing and tracking overpayments from providers and collaborating with internal teams to resolve complex cases.

The position requires a minimum of 3 years of related experience, strong analytical abilities, CPT/ICD-10 knowledge, and proficiency with Excel and Word. Remote work is supported.

Qualifications

• Minimum 3 years of equivalent work experience required.
• Strong analytical skills and knowledge of computer systems.
• Knowledge of CPT and ICD-10 coding terminology is preferred.
• Proficient in Excel and Word.
• Strong written and verbal communication skills.

Responsibilities

• Review and evaluate refund requests for accuracy, eligibility, and compliance.
• Investigate discrepancies in claims, payments, and billing to determine refund actions.
• Process refunds per company policies, contractual obligations, and regulatory requirements.
• Contact providers for status updates on refund requests.
• Collaborate with billing, finance, customer service, and provider relations to resolve complex cases.

Skills

Analytical skills

CPT/ICD-10 knowledge

Claims recovery experience

Strong written and verbal communicate

Accountability

Customer service orientation

Time management

Education

High school diploma or equivalent

Tools

Excel

Word

Job description

POSITION SUMMARYThe Senior Refund Specialist will review, analyze, and make determinations regarding solicited refunds based upon specific claim guidelines and plan benefits. Prepare and track overpayments from providers for solicited refunds.ESSENTIAL FUNCTIONSReview and evaluate refund requests associated with claims for accuracy, eligibility, and complianceInvestigate discrepancies in claims, payments, and billing to determine appropriate refund actionsProcess refunds in accordance with company policies, contractual obligations, and regulatory requirementsContact providers for status updates on refund requestCollaborate with internal teams (e.g., billing, finance, customer service, provider relations) to resolve complex casesRead, analyze, understand, and ensure refunds are handled in compliance with clients’ Summary Plan DescriptionsPrepare and track overpayment request letters to providersReview, analyze and add applicable notes to the overpayment logAssist and support team members as needed and when requestedOther duties as assignedEDUCATIONHigh school diploma or equivalent requiredEXPERIENCE AND SKILLSMinimum 3 years of equivalent work experience requiredStrong analytical skills and knowledge of computer systemsKnowledge in CPT and ICD-10 coding terminologyClaims recovery experience preferredProficient in the use of the Excel and Word programsStrong written and verbal communication skills requiredPOSITION COMPETENCIESAccountabilityCommunicationCustomer Service OrientationFunctional/Technical SkillsQuality FocusTime and Task ManagementPHYSICAL DEMANDSThis is a standard desk role requiring extended periods of sitting and computer work.WORK ENVIRONMENTRemoteHere 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 and 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.