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Role Description

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
• 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

Qualifications

• Bachelor's degree or equivalent work experience required

Requirements

• 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

Benefits

• Medical, Dental, Vision, Life & Disability Insurance
• Generous Paid Time Off
• Tuition Reimbursement
• EAP
• Technology Stipend

Work Environment

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

Remote work is supported with a requirement for a reliable internet connection through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload.