Claims Specialist

Claims Specialist

Immediate 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.