This position is a temporary assignment. As a contractor, you’ll be employed by Magnit, not The Cigna Group or any subsidiaries of The Cigna Group.

LOCATION AND SCHEDULE:

This is a fully remote role open to candidates across the US.

ROLE OVERVIEW: 37530549  - Claims Senior Representative

The Claims Senior Representative – Refunds is responsible for researching, reviewing, and processing patient and insurance refund requests resulting from overpayments, duplicate payments, coordination of benefits adjustments, claim reprocessing, and billing corrections. 

The position works closely with Revenue Cycle, Finance, Customer Service, Account Management, and Health Plan partners to ensure refunds are processed accurately, timely, and in compliance with internal policies, payer requirements, and regulatory guidelines. 

The ideal candidate possesses strong analytical skills, a thorough understanding of the healthcare claims lifecycle, and experience managing patient and payer overpayment scenarios.

ESSENTIAL 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, coordination of benefits issues, and payment posting discrepancies.

Process payer refund requests, takebacks, recoupments, and offset requests.

Perform account audits to ensure billing accuracy and identify improper charges or payment variances.

Maintain refund work queues, shared mailboxes, and ticketing systems within established service levels.

Create and document account adjustments, refunds, write-offs, and corrective actions.

Work with Finance and Treasury teams to reconcile refund transactions and outstanding liabilities.

Monitor aging refund balances and ensure timely resolution.

Respond to internal and external inquiries regarding refund status and payment research.

Escalate complex refund issues, system defects, or compliance concerns to leadership.

Assist with monthly reconciliation activities, audit requests, and reporting.

Identify trends and process improvement opportunities related to refunds and overpayments.

Maintain detailed documentation supporting all refund decisions and transactions.

Participate in testing and validation of billing, refund, and payment system enhancements.

Provide training and guidance to team members regarding refund processes and best practices.

Perform additional duties and special projects as assigned.

 

REQUIRED QUALIFICATIONS:

Minimum 3+ years of healthcare Revenue Cycle Management experience.

Minimum 2 years of experience in refunds, overpayments, cash posting, AR follow-up, or claims processing.

Strong knowledge of commercial, Medicare, Medicaid, and employer-sponsored health plans.

Ability to interpret EOBs, ERAs, payer correspondence, and refund requests.

Experience working within EMR/PM systems such as Athenahealth preferred.

Proficiency in Microsoft Excel, Word, and Outlook.

SKILLS & EXPERINCE:

Strong understanding of the healthcare claims lifecycle.

Knowledge of patient and payer refund regulations and compliance requirements.

 

Excellent analytical and problem-solving skills.

Strong attention to detail and accuracy.

Ability to prioritize workloads and meet deadlines in a high-volume environment.

Effective verbal and written communication skills.

Ability to work independently and collaboratively across multiple departments.

Experience identifying root causes and implementing process improvements.

PREFERRED 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.

Experience supporting audits and regulatory reviews.

EDUCATION:

High School Diploma or Equivalent required.

Associate’s or Bachelor’s degree in business, Finance, Healthcare Administration, or related field preferred.

Hourly Pay Rate Range (dependent on location, experience, expectation):
The pay range that Magnit reasonably expects to pay for this position is: $16.00/hour-$16.00/hour  
Benefits: Medical, Dental, Vision, 401K (provided minimum eligibility hours are met) 
 

Tundra Technical Solutions (the operator of this Talent Community) is a global leader of contingent talent services. Our success and our clients’ success are built on a foundation of service excellence. We are an equal opportunity employer, and we do not discriminate on the basis of race, religion, color, national origin, sex, sexual orientation, age, veteran status, disability, genetic information, or other applicable legally protected characteristic. Qualified applicants with arrest or conviction records will be considered for employment in accordance with applicable law, including the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. Unincorporated LA County workers: we reasonably believe that criminal history may have a direct, adverse and negative relationship with the following job duties, potentially resulting in the withdrawal of a conditional offer of employment: client provided property, including hardware (both of which may include data) entrusted to you from theft, loss or damage; return all portable client computer hardware in your possession (including the data contained therein) upon completion of the assignment, and; maintain the confidentiality of client proprietary, confidential, or non-public information. In addition, job duties require access to secure and protected client information technology systems and related data security obligations. 

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.