Teams at Allied Benefit Systems Inc

Manages chronic-condition cases by reviewing clinical and claims information, developing and implementing member care plans, coordinating with clinicians, vendors, clients, and members, and communicating with CMS. The role supports prescription drug vendor relationships, documents cost and health outcomes, resolves escalated issues, maintains case records, and improves internal processes. This is a fully remote position requiring strong communication, organization, analytical skills, and experience with group health insurance and self-funded health plans.

Prepares, submits, monitors, reconciles, and appeals aggregate medical stop loss claims for carrier reimbursement. Reviews policy provisions and plan documents, audits funding positions, tracks balances, maintains supporting documentation, and communicates with carriers, brokers, clients, and internal departments to resolve issues and meet filing deadlines.

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.