Refund Collection Analyst - Remote

About the role

The Refund Collection Analyst provides day-to-day operational support and leadership within RCM Refunds and Billing, with responsibility for patient and insurance refund workflows and account reconciliation activities. The role supports process standardization, identifies and resolves complex refund and reconciliation issues, guides team members, and serves as an escalation point for refund, billing, and reconciliation matters.

Essential Job Functions

• Lead patient and payer refund processing in accordance with RCM policies, payer guidelines, and internal controls.
• Resolve complex refund, billing, and claim-related issues, including overpayments, duplicate payments, improper charges, and payment discrepancies.
• Perform account reconciliations to identify and resolve discrepancies, unapplied payments, credit balances, and other outstanding account issues.
• Audit patient and payer accounts to identify billing errors, validate transactions, determine refund eligibility, and initiate appropriate corrective actions.
• Monitor refunds and billing-related complaints, reconciliation issues, and workflow trends, escalating systemic or recurring issues to management.
• Partner cross-functionally with RCM, Finance, Enrollment, Billing, and Customer Service to resolve refund, billing, payment, and reconciliation issues and improve operational processes.
• Serve as an escalation resource for complex refund, billing, and account reconciliation matters while supporting day-to-day workflow needs.
• Track refund volumes, reconciliation results, audit findings, aging, and operational trends and provide updates to management during weekly and month-end reporting.
• Provide audit feedback, process guidance, and remedial training to team members as needed.
• Support workflow standardization by identifying process gaps, recommending improvements, and helping ensure established procedures and internal controls are followed.
• Complete day-to-day Enrollment/Billing responsibilities independently, with access to management or more experienced team members for guidance on complex or unusual matters.
• Complete other projects and duties as assigned.

Qualifications

• Must be a current employee or contractor with The Cigna Group, Evernorth Health Services, or one of their subsidiaries.
• High school diploma or GED required; Bachelor's degree in finance or related field preferred
• MDLive experience preferred
• Working knowledge of RCM refund policy
• Strong analytical and problem-solving skills with the ability to identify effective and efficient solutions
• Experience reviewing financial transactions and resolving billing or payment discrepancies is preferred
• Proficiency in working with Microsoft Office products: Excel, Word
• Working knowledge of Health Insurance EOB's
• Ability to meet assigned deadlines
• Strong understanding of the claims cycle
• Capable of finding effective and efficient solutions to challenges
• Must be able to work in a fast-paced, high-volume work environment

Additional information

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.