Healthcare Claims Refund Specialist

This is a fully remote position, open to applicants in Florida.

📋 Description

• Conduct audits, reviews, and modifications of medical, dental, and flexible spending accounts as well as Health Reimbursement Account claims.

• Create, review, and apply refund letters for all lines of business directed to members and providers.

• Reprocess payments when required.

• Engage with members, providers, employer group contacts, and other inquirers regarding specific refund inquiries.

• Examine plan documents for various groups to investigate and resolve claim processing questions and concerns.

• Act promptly to address inquiries related to the status of refund requests, including research and resolution of outstanding requests.

• Carry out other associated duties as assigned.

⛳️ Requirements

• Minimum of 6 months’ experience in the healthcare or insurance sector concerning operations support, which includes provider maintenance, billing, coding, or customer support.

• Experience in healthcare billing or a background with a health insurance carrier or Third-Party Administrator is highly preferred.

• Strong time-management abilities, capable of prioritizing multiple tasks while maintaining a sense of urgency.

• Excellent interpersonal skills along with strong verbal and written communication capabilities.

• Proficient keyboard and basic Windows computer skills are necessary.

• Familiarity with Microsoft Excel is required.

• A keen interest in learning about the TPA industry and new concepts and processes.

🏝️ Benefits

• Outstanding medical, dental, and vision insurance*

• Biannual employer HSA contributions, covering 50% of the annual deductible for the HDHP plan!

• Basic Life and AD&D insurance provided by the company

• Company-paid Short-Term and Long-Term Disability coverage**

• Flexible Spending Accounts*

• 401(k) Retirement Plan with an employer match of up to 6%**

• WOW! (100% fully vested after 3 years)

• Over 10 paid holidays

• Half-day Fridays during the summer

• Generous paid vacation and sick leave

• Annual Paid Volunteer Day

• Annual Tuition Reimbursement

• Annual Health and Wellness Reimbursement

• Numerous enjoyable company events