What are the responsibilities and job description for the Claims Refund Specialist position at The Forum Group?
Insurance Refund Specialist
Experienced Insurance Refund Specialist seeking an opportunity to support a healthcare organization with complex refund, overpayment, and credit balance resolution across Commercial Managed Care, Medicare HMO, and Medicaid HMO accounts. Highly specialized in Medicare Secondary Payer (MSP) refunds, with additional expertise in Workers’ Compensation, No-Fault, and Out-of-Network (OON) refund processing.
Demonstrated success in identifying, researching, and resolving insurance overpayments and credit balances, including filing online recoupment and refund requests through payer portals, while ensuring strict compliance with CMS and payer-specific regulations. Known for strong analytical and mathematical skills, attention to detail, and the ability to manage high-volume refund inventories with accuracy, timeliness, and persistence. Effective communicator with internal revenue cycle teams and external payers to ensure complete and compliant resolution.
Core Expertise Includes:
Medicare MSP refunds and coordination of benefits
Commercial Managed Care, Medicare HMO, and Medicaid HMO overpayment review and refund processing
Online recoupment and refund request submission through payer portals
Identification, analysis, and resolution of credit balances and overpayment requests
Workers’ Compensation and No-Fault refund processing
CMS refund requirements, documentation, and demand letter management
Research, reconciliation, and validation of complex payer credit balances
Microsoft Office skills, including Excel
Strong mathematical aptitude for payment validation and refund accuracy
Communication with Medicare contractors, Managed Care organizations, WC carriers, and commercial payers
Audit readiness and compliance-driven refund workflows
Independent account review with detailed tracking and follow-through
Pay: $30.00 - $31.00 per hour
Work Location: In person
Salary : $30 - $31