• Review and complete provider solicited and unsolicited overpayment refunds and returned checks • Research, resolve, and adjudicate complex, sensitive, and/or specialized medical claims • Collaborate and partner with key business functions to ensure accuracy in posting overpayment refunds • Process complex non-routine Provider Refunds and Returned Checks • Review and interpret medical contract language using provider contracts to confirm whether a claim is overpaid • Apply medical necessity guidelines, determine coverage, complete eligibility verification • Ensure compliance requirements are satisfied • Handle telephone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals • Review and handle relevant claims data mining work assigned to the team