Claims Payment Specialist

Job Description

Job Description

Claims Payment Specialist, IDR

The Claims Payment Specialist manages payment reconciliation, tracking, and refund administration for Federal Independent Dispute Resolution operations. This role works directly with stakeholders and internal teams to ensure accurate payment processing, dispute resolution, reporting, recordkeeping, and compliance with financial controls.

DUTIES:

• Review daily bank activity and identify incoming payments and deposits.
• Match remittance information to payments and maintain accurate records.
• Determine the source of payments, including providers, health plans, and other entities.
• Link payments to the appropriate disputes and transaction records.
• Research payments received without remittance documentation and identify related disputes.
• Maintain complete documentation and audit trails for payment activity, updates, adjustments, and account records.
• Respond to payment inquiries, remittance requests, and refund requests from providers, health plans, and other stakeholders.
• Partner with Accounting to support payment processing, reconciliation, and reporting.
• Prepare and distribute daily transaction reports.
• Monitor payment activity, outstanding items, workload, and operational metrics using system reports and tracking tools.
• Research and resolve unmatched transactions and payment discrepancies.
• Review disputes for closure when payment has not been received and document outcomes appropriately.
• Prepare and maintain bi-monthly closed-dispute reports, including data validation and cleanup.
• Maintain payor refund addresses and payment information.
• Support the setup of new ACH vendors.
• Review payment activity to determine refund eligibility, amounts, and recipients.
• Prepare refund requests and supporting documentation for approval and processing.
• Maintain records of issued checks, EFTs, remittances, and related financial documentation.
• Respond to inquiries regarding payment requirements, payment status, and refund processing.
• Meet internal deadlines and CMS requirements.
• Support audits, process improvements, reconciliation projects, and other special assignments.

QUALIFICATIONS:

• Experience researching payment discrepancies, reconciling transactions, and maintaining financial records.
• Advanced Microsoft Excel skills, including formulas, pivot tables, sorting, filtering, and data validation.
• Experience using financial systems, databases, case management platforms, or CRM tools such as Salesforce.
• Strong attention to detail and accuracy in a high-volume environment.
• Excellent organizational and time-management skills with the ability to manage competing priorities.
• Experience working with project management tools and electronic document systems.
• Strong written and verbal communication skills.
• Ability to work independently while collaborating effectively across departments.
• Healthcare claims processing, payment reconciliation, or dispute resolution experience preferred.
• Strong problem-solving skills and the ability to work effectively with cross-functional teams.
• Ability to adapt, multitask, and meet deadlines in a fast-paced environment.

EDUCATION & EXPERIENCE:

• Bachelor’s degree in Business Administration, Finance, Accounting, Healthcare Administration, or a related field preferred, AND one (1) year of experience in financial operations, accounts receivable, payment processing, claims administration, or payment reconciliation, required.

-OR-

• Associate degree in Business Administration, Finance, Accounting, Healthcare Administration, or a related field preferred, AND two (2) years of experience in financial operations, accounts receivable, payment processing, claims administration, or payment reconciliation, required.

The salary range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. The salary range for this position is $66,300.00 to $70,000.00. Actual salary and/or hourly rate depends on a variety of factors including experience, education, credentials, location, and budget.

The salary range listed does not include other forms of compensation or benefits.

IPRO is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, protected veteran status or military status.