Jobs at Allied Benefit Systems Inc

Supervise analysts and reporting coordinators delivering accurate analytics, dashboards, and data outputs. Review and validate reports, lead complex data modeling and KPI initiatives, translate business questions into analytical solutions, improve query and reporting processes, and modernize the reporting stack through automation and self-service capabilities. Provide technical mentorship, establish data governance and documentation standards, manage performance, and support continuous improvement across the analytics function.

Leads Claims Distribution and Repricing projects from initiation through delivery, coordinating timelines, meetings, stakeholders, and communications. Reviews department workflows, systems, procedures, and data to identify process improvements, then recommends enhancements to management. Requires strong analytical, organizational, communication, spreadsheet, database, and business skills, along with proficiency in Smartsheet, SharePoint, and Excel. This is a remote desk-based role.

Processes inbound and outbound EDI files, including 837 claim conversions, file transfers, encryption, reconciliation, eligibility matching, reporting, and failed transaction resolution. Conducts departmental audits, supports internal staff and external trading partners, routes claims accurately, handles projects and complex issues, and trains EDI Coordinators on workflow and procedure updates. The role requires strong data-entry accuracy, analytical and problem-solving skills, and proficiency with Word, Excel, and Access in a remote work environment.

Facilitates Scrum events and supports cross-functional Agile teams by removing blockers, tracking progress, managing risks, mentoring team members, and promoting continuous improvement. Coordinates sprint planning, reviews, retrospectives, demos, testing, schedules, deliverables, financial tracking, and stakeholder status reporting. This is a fully remote desk role requiring strong communication, analytical, leadership, and project management skills.

Reprices medical and dental claims using PPO network applications, keys claims into QicLink, resolves escalated issues, communicates with internal departments, maintains 99% accuracy, trains team members on workflow updates, and supports EDI issues and client-specific product implementations. The role is fully remote and requires high-volume data entry and familiarity with medical claim forms.

Manages claims processing teams, inventories, productivity, quality, service-level compliance, audits, escalated claim reviews, and client requirements. Leads process improvement through data analysis, forecasting, and workflow enhancements. Coaches and develops employees, supports new clients and products, and ensures compliance with plan documents, regulatory standards, HIPAA, HITECH, and privacy requirements.

Manages setup and daily operations of eligibility technology platforms, including system configuration, enrollment changes, renewals, open enrollment, audit reviews, member updates, data transfers, and troubleshooting. Provides client training and technical support, conducts quality assurance testing, maintains data integrity protocols, and coordinates issue escalation with internal and external partners. The role requires benefits administration technology experience, intermediate Word and Excel skills, basic Access knowledge, and strong communication abilities.

Drives new business growth through broker and consultant relationships, sales strategy, complex negotiations, product positioning, and revenue maximization. Manages renewals, RFPs, open enrollment presentations, routine account service, and client issues while collaborating with account management, underwriting, and vendors. Represents the company at business functions and supports training activities.

Lead ANSI X12-834 eligibility EDI implementations, including partner onboarding, file configuration, mapping, testing, monitoring, troubleshooting, and production support. Coordinate internal teams and external vendors, investigate eligibility data discrepancies, manage implementation timelines, document configurations, and improve data quality and operational processes. Serve as a subject matter expert for eligibility data exchange while providing project updates and technical recommendations to leadership and stakeholders.

Prepare and submit medical stop loss claims, monitor carrier reimbursement status, provide supporting documentation, resolve claim issues, reconcile filings, and appeal denied or reduced reimbursements. Interpret stop loss contracts and plan documents, communicate with carriers, brokers, clients, and internal teams, and maintain accurate records while meeting filing deadlines and department metrics in a remote environment.

Assists with healthcare case management escalations, vendor and client relationships, process improvements, workflow documentation, staff training, and complex issue resolution. Collaborates with internal departments, external partners, and vendors while providing backup support to the Senior Case Management Liaison. Requires healthcare or health insurance experience, medical terminology knowledge, strong communication skills, and proficiency with Microsoft Office applications. The position is fully remote.

Reviews and prioritizes incoming referrals, assigns team workloads, manages BCBS and Anthem claim adjustments, updates member accumulators, closes claims, runs reports, tracks special projects, maintains workflows, trains staff, and supports claim operations and refund processes.

Organize and complete claim appeals: review appeals and Summary Plan Documents, compose response letters, communicate with internal teams and clients, document statuses in QicLink, email examiners/units, and prioritize referrals to meet deadlines.

Manage and grow a portfolio of client accounts by handling renewals, preparing RFPs, coordinating with underwriting and stop-loss vendors, supporting open enrollments and member issues, producing ad-hoc reports, and collaborating with internal teams to resolve routine account problems.

Support development and maintenance of security controls and compliance programs. Manage frameworks (SOC 2, HIPAA, NIST), optimize Drata, support audits, perform vendor risk assessments, maintain risk register, track remediation, and promote security awareness across the organization.

Execute end-to-end group medical premium billing: import/validate billing files in QicLink, generate/distribute invoices, resolve discrepancies, manage account setups, audit configurations, maintain reporting, and improve billing processes.

Process and submit client invoices, follow up on payments and resolve discrepancies, maintain billing/collection records, assist month-end close and reporting, set up/change/audit client accounts, and create/maintain Excel and Access reports.

Lead implementation of operational projects, new products, services, and vendor relationships through PMO frameworks. Develop project plans, track milestones, manage risks and QA, run meetings, report status, guide change management, optimize processes, and ensure timely delivery while collaborating with cross-functional teams and ensuring alignment with PMO standards.

Supervise stop loss operations including auditing claim filings, tracking reimbursements and deductibles, filing aggregate and Rx stop loss claims, organizing ACH reimbursements, making claim adjustments, and coaching a small team to ensure accurate, timely processing.

Lead delivery of GenAI, predictive modeling, semantic search, and automation across business workflows. Define AI product roadmaps and requirements, coordinate engineering and data science teams, ensure MLOps/cloud deployments, manage stakeholder change and training, and ensure compliance with responsible AI governance and ISO 42001 audit readiness.