Claims Refund Clerk

Job Description

Job Description

Description :

Summary : The Claims Refund Clerk would support the Claims Department and work within the TPL / COB Team.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Works on site with consistent and reliable attendance.
• Provider Gateway Support : Will support the registration process of the Provider Gateway system currently in place and monitored / managed by the TPL / COB Team, to include : monitoring of the communications of the “pending registrations” for Providers attempting to complete their information and manage online queries for status by same. Tracking to completion of registration(s) and monthly statistics of relevant registrations.
• Responsible for tracking / logging duties and procedures associated with incoming refunds and overpayments pertaining to claims, including : compares data on claim with internal policy and other company records to ascertain completeness and validity of claim, maintains high quality standards to avoid paying claim incorrectly, refers most questionable claims for investigation to Supervisor for review, handle incoming refunds and overpayment checks pertaining to claims, log and track all refund checks that are being researched. Maintain status on refund log spreadsheet. Research as needed. Working interdepartmentally is critical to completion of this process.
• Performs other duties and responsibilities as assigned by Management.

Work Environment : The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.

Requirements :

Knowledge, Skills, & Abilities :

Supervisory Responsibilities : This job has no supervisory responsibilities.

Qualifications : To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and / or Experience : High school or G.E.D. equivalent; and minimum of two years of increasingly responsible office administrative, specialized administrative support or secretarial experience and / or training; or equivalent combination of education and experience.

Language Skills : Ability to read, speak, and write effectively in English. Ability to read, speak, and write effectively in English. Ability to interpret documents such as safety rules, memos, letters, and forms. Ability to write routine reports and correspondence. Ability to speak effectively before customers or employees of an organization. Ability to effectively address or resolve customer service issues within guidelines of the position.

Mathematical Skills : Ability to add and subtract figures. Ability to add and subtract, multiply and divide with 10's and 100's.

Reasoning Ability : Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

Certificates, Licenses, Registrations : None.

Physical Demands : The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit for extended periods in front of a computer. The employee is frequently required to reach with hands and arms and talk or hear. The employee is occasionally required to stand; walk and use hands to finger, handle, or feel.