Medical Claim Refund Analyst

Refund Analyst

Position Summary

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.

Essential Functions

• 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
  
  

EDUCATION

• Bachelors degree or equivalent work experience required.
  
  

Experience & Skills

• 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
  
  

COMPETENCIES

• Job Knowledge
• Time Management
• Accountability
• Communication
• Initiative
• Customer Focus
  
  

PHYSICAL DEMANDS

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

WORK ENVIRONMENT

• Remote
  
  

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.