Healthcare Claims Refund Specialist

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

📋 Description

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

• Draft, apply, and issue refund letters for all business lines directed to members and providers.

• Reprocess payments when deemed necessary.

• Engage in communication with members, providers, employer group contacts, and other inquiries related to specific refund queries.

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

• Respond with urgency to inquiries regarding the status of refund requests, including research and resolution of outstanding requests.

• Perform additional related tasks as assigned.

⛳️ Requirements

• A minimum of 6 months’ experience in the healthcare or insurance sector focusing on operations support, including provider maintenance, billing, coding, or customer support.

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

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

• Excellent interpersonal skills, complemented by strong verbal and written communication abilities.

• Basic keyboard skills and proficiency in Windows-based computer applications are required.

• Familiarity with Microsoft Excel is necessary.

• A willingness to learn about the TPA industry and new concepts and processes.

🏝️ Benefits

• Exceptional medical, dental, and vision insurance*

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

• Company-provided Basic Life and AD&D insurance

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

• Flexible Spending Accounts*

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

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

• More than 10 paid holidays

• Generous paid vacation and sick leave

• Annual Volunteer Paid Day

• Annual Tuition Reimbursement

• Annual Health and Wellness Reimbursement

• Numerous enjoyable company events