Note: Individuals typically begin between the minimum to middle of the pay range
Process, review, balance, and post benefit payments accurately and timely. Ensures benefit payments to providers and members are balanced and disbursed based on the scheduled payment cycles and process refunds timely. Research and respond to payment-related inquiries. Prepare monthly journals and adjusting journal entries and analyze GL account reconciliations. Assist with analysis of financial data and prepare special reports as assigned.
Minimum Qualifications
Associates degree and one year of related work experience; or equivalent combination of education and comparable work experience.
Basic working knowledge of Microsoft Office applications. Including but not limited to Word, Excel, Outlook, and PowerPoint.
Duties and Responsibilities
Process benefit or refund payments to Providers, Members, and Groups.
Submit invoices for approval and process payments based on Federal and State reporting guidelines.
Research and resolve payment inaccuracies and effectively communicate with vendors, business-associates, and government agencies for payment-related issues.
Research and respond to benefit payment inquiries timely and accurately.
Monitor incoming inquiries received for multiple lines of business and coordinate assignments of aging or rush inquiries.
Research and resolve complex inquiries and assist staff to resolve issues as needed.
Balance system-generated claims payments to ensure that payment amount is correct and agrees with balancing reports.
Research and resolve payment balancing discrepancies.
Identify impacts to payment balancing for updates to mandates or changes in business requirements.
Identify key controls for audit reviews.
Prepare and review monthly journals for posting to GL on a timely basis.
Perform G/L and bank account reconciliations.
Research discrepancies and perform corrective action to clear discrepancies.
Prepare audit workpapers as assigned and respond to audit inquiries.
Assist with analysis of financial data and research and resolve discrepancies identified on payment balancing or account reconciliation reports.
Review payment-related claims transactions and assist with resolving issues related to payments, refunds, negative balance, deducts, etc.
Prepare special reports as assigned on a timely basis. This includes preparing work for analysis of data to determine reasonable and allowable cost, to perform budget projections, to track statistical data, or to determine working capital analysis.
Prepare policies and procedures and workflows for business processes. Identify solutions on process efficiencies. Provide staff training as needed.
Performs all other miscellaneous responsibilities and duties as assigned or directed.
Including review and processing of refund checks, return mail, scanning and filing, check pick-up, stop payment, void processing, EFT requests, etc.
Seniority level
Entry level
Employment type
Full-time
Job function
Accounting/Auditing and Finance
Industries
Insurance
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