Healthcare Claims Refund Specialist

Job Description

Job Description

Description:

Join our team at Cobalt Benefits Group and start an exciting new career in employee benefits solutions. As a Claims Refund Specialist , you’ll play an important role in helping us offer customized, self-funded insurance options to our clients and members. The Refund Specialist is responsible for various administrative tasks related to services and claims for our health plans such as addressing queue claims, reviewing summary plan documents, processing refunds and overpayments, documentation, and reporting. At Cobalt Benefits Group, we operate on a member first approach, always providing the best service possible to our members and partners. The ideal candidate is detail-oriented, with exceptional communication skills, and a background in healthcare/insurance processing.

We are hiring for multiple positions with a mandatory start date of Tuesday, September 15, 2026

Key Responsibilities

• Audit, review, and adjust medical, dental, and flexible spending accounts and Health Reimbursement Account claims.
• Review, apply and create refund letters for all lines of business to members and providers.
• Reprocess payments when necessary.
• Communicate with members, providers, employer group contacts, and other inquirers pertaining to specific refund questions.
• Review plan documents for various groups to research and resolve claim processing questions and issues.
• Act with urgency to respond to inquiries regarding refund request status-including research and resolution regarding outstanding request.
• Perform other related duties, as assigned.

• 6 months’ experience in healthcare or insurance industry with respect to operations support, including provider maintenance, billing, coding, or customer support.
• Experience in health care billing or a background with a health insurance carrier or Third-Party Administrator strongly desired.
• Solid time-management skills, with the ability to prioritize multiple tasks, while working with a sense of urgency.
• Strong interpersonal skills with excellent verbal and written communication skills.
• Basic keyboard and Windows based computer skills required.
• Familiarity with Microsoft Excel.
• Eager to learn the TPA industry and new concepts and processes.

Work Environment & Physical Demands

• Prolonged periods of sitting may be required.
• Regular use of a computer, keyboard, and mouse is necessary; reasonable accommodations will be provided upon request.
• Employees should ensure an ergonomically appropriate desk and chair setup.
• Comfort with being on camera for virtual meetings (e.g., Microsoft Teams)

Benefits

After successfully completing a waiting period, eligible Full-time employees have access to our comprehensive benefits package, including:

• Fantastic medical, dental, and vision insurance*
• Twice annual employer HSA contributions, covering 50% of the HDHP plan’s annual deductible!
• Company provided Basic Life and AD&D
• Company paid Short-Term and Long-Term Disability**
• Flexible Spending Accounts*
• 401(k) Retirement Plan with up to a 6% employer-match** WOW! (100% fully vested after 3 years)
• 10+ paid holidays
• Generous paid vacation and sick time
• Annual Volunteer Paid Day
• Annual Tuition Reimbursement
• Annual Health and Wellness Reimbursement
• Lots of fun company events

Benefit Waiting Period Notes: *60 day waiting period **90 day waiting period

Who We are
As a trusted third-party administrator (TPA) specializing in self-funded benefit plans, Cobalt Benefits Group (CBG) is committed to helping employers find high-quality coverage at a cost they can afford. We administer self-funded insurance benefits through our four companies: EBPA, Blue Benefit Administrators of Massachusetts, CBA Blue and Great Bay Administrators. With over 30 years of experience and a dedicated team of nearly 300 employees, we work collaboratively to build customized self-funded health plans, manage claim payments and disputes, and administer other specialized programs such as FSAs, HSAs, COBRA, and retiree billing. Join us as we match employers across our region with the right solutions for their employee benefit needs. To learn more about working at CBG, visit