Senior Refund Specialist

POSITION SUMMARY
The Senior Refund Specialist will review, analyze, and make determinations regarding solicited refunds based upon specific claim guidelines and plan benefits.  Prepare and track overpayments from providers for solicited refunds.

ESSENTIAL FUNCTIONS

- Review and evaluate refund requests associated with claims for accuracy, eligibility, and compliance

- Investigate discrepancies in claims, payments, and billing to determine appropriate refund actions

- Process refunds in accordance with company policies, contractual obligations, and regulatory requirements

- Contact providers for status updates on refund request

- Collaborate with internal teams (e.g., billing, finance, customer service, provider relations) to resolve complex cases

- Read, analyze, understand, and ensure refunds are handled in compliance with clients’ Summary Plan Descriptions

- Prepare and track overpayment request letters to providers

- Review, analyze and add applicable notes to the overpayment log

- Assist and support team members as needed and when requested

- Other duties as assigned

EDUCATION

- High school diploma or equivalent required

EXPERIENCE AND SKILLS

- Minimum 3 years of equivalent work experience required

- Strong analytical skills and knowledge of computer systems

- Knowledge in CPT and ICD-10 coding terminology

- Claims recovery experience preferred

- Proficient in the use of the Excel and Word programs

- Strong written and verbal communication skills required

POSITION COMPETENCIES

- Accountability

- Communication

- Customer Service Orientation

- Functional/Technical Skills

- Quality Focus

- Time and Task Management

PHYSICAL DEMANDS

- This is a standard desk role requiring extended periods of sitting and computer work.

WORK ENVIRONMENT

- Remote

Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive .

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.

Compensation is not limited to base salary.  Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life and Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.

Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time.  All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process.  It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.