Lead Refund Processing Specialist

2 weeks ago


Philadelphia, Pennsylvania, United States Independence Blue Cross Full time
Job Overview:

As a Senior Refund Operations Analyst, you will play a crucial role in enhancing the efficiency of our refund processes. Your expertise will guide the team in resolving complex issues and ensuring a seamless workflow.

Key Responsibilities:
  • Facilitate the training and development of both new and existing refund analysts.
  • Provide technical support to the management team and assist in resolving queries from team members.
  • Manage the processing of system credits related to refunds and returned checks for various groups.
  • Deliver exceptional customer service regarding refund inquiries for both internal and external stakeholders.
  • Draft and dispatch refund request letters in accordance with established guidelines, ensuring timely follow-ups.
  • Engage with remote groups to address check and void discrepancies, and undertake projects as necessary.
  • Support team members in navigating complex system adjustments and customer service challenges.
  • Oversee and coordinate daily operations among team members to maintain productivity.
  • Offer guidance to refund analysts across all plan types and business lines.
  • Participate in special projects requiring proficiency in Excel and Word.
  • Assume auditing responsibilities for new hires until performance objectives are achieved.
  • Foster a collaborative team environment that encourages productivity and engagement.

Position Qualifications:

  • A minimum of 5 years of experience in claims processing.
  • Demonstrated leadership capabilities.
  • Familiarity with the claim payment and adjustment systems used by AmeriHealth Administrators.
  • Ability to inspire and delegate tasks effectively.
  • Strong problem-solving aptitude.
  • Exceptional organizational skills with a keen attention to detail.
  • Excellent written and verbal communication abilities.
  • Knowledge of ICD-9, CPT-4, and HCPCS coding.
  • A college degree or equivalent experience is preferred.


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