Jobs at Allied Benefit Systems Inc

Reviews medical, dental, and vision claim appeals and supporting documentation, evaluates appeal validity against Summary Plan Documents, prepares response letters, communicates with internal teams and clients, updates QicLink records, prioritizes referrals, and ensures timely, accurate documentation and outcomes. This is a fully remote desk-based role requiring strong communication, analysis, organization, and claims-handling experience.

Implements and maintains client networks and vendors, coordinates assignments with implementation teams, manages external network contacts, resolves escalated issues, communicates updates, develops tracking and reporting, audits completed work, and maintains client records. The role requires strong organization, communication, attention to detail, multitasking, sales support experience, and proficiency with Microsoft Office applications.

Leads daily claims processing operations, overseeing inventory, productivity, quality, compliance, and service levels. Supervises, coaches, and develops claims staff; handles escalated claims and stakeholder concerns; supports implementations, audits, workflow improvements, and regulatory adherence. Ensures accurate processing according to plan documents, client expectations, and applicable requirements.

Supports business projects and process improvements by analyzing workflows, developing KPI reports, documenting procedures, piloting new processes, resolving enhancement requests, and bridging technical and non-technical teams. Requires SQL Server and report-writing experience, with preferred expertise in Microsoft Office, VBA, and Access. This is a fully remote desk-based role.

Coordinates maternity and other health-related cases by reviewing clinical and claims information, developing care plans, arranging referrals, communicating with members, clients, vendors, carriers, CMS, and clinicians, and monitoring outcomes and cost savings. The role also manages prescription drug vendor relationships, supports escalated case discussions, documents casework, troubleshoots processes, and completes administrative tasks in a fully remote environment.

Processes repricing adjustments, exception referrals, RX refunds, accumulator updates, and claim recalculations. Reviews claim calculations and claimant history for accuracy, collaborates with claims personnel, and tracks assigned projects. Requires medical claims processing experience, analytical skills, strong communication, and proficiency with Microsoft Office tools. This is a remote office-based role.

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.

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.

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.

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.

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.