Claims Specialist

Claims SpecialistImmediate need for a talented Claims Specialist. This is a 06+months contract opportunity with long-term potential and is located in U.S(Remote). Pay Range: $15 - $18/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).Key Responsibilities:Review and process patient and insurance refund requests in accordance with company policy and regulatory requirements.Research patient accounts to determine refund eligibility and validate overpayment balances.Analyze remittance advice, EOBs, adjustment activity, and payment history to identify refund opportunities.Investigate and resolve overpayments, duplicate payments, and payment posting discrepancies.Process payer refund requests, takebacks, recoupments, and offset requests.Maintain refund work queues, shared mailboxes, and ticketing systems within established service levels.Create and document account adjustments, refunds, write-offs, and corrective actions.Monitor aging refund balances and ensure timely resolution.Respond to internal and external inquiries regarding refund status and payment research.Escalate complex refund issues or compliance concerns to leadership.Identify trends and process improvement opportunities related to refunds and overpayments.Provide training and guidance to team members regarding refund processes and best practices.Key Requirements and Technology Experience:Experience with patient refund processing and insurance overpayment recovery.Experience with reconciliation and month-end accounting support.Familiarity with Jira or other workflow management systems.3-5 years of healthcare Revenue Cycle Management experience.2 years of experience in refunds, overpayments, cash posting, AR follow-up, or claims processing.High school diploma or equivalent required; Associate or bachelor's degree in business, Finance, Healthcare Administration, or related field preferred.Strong knowledge of commercial, Medicare, Medicaid, and employer-sponsored health plans.Ability to interpret EOBs, ERAs, payer correspondence, and refund requests.Proficiency in Microsoft Excel, Word, and Outlook.Familiarity with EMR/PM systems such as Athenahealth preferred. Pyramid Consulting