Jobs at Allied Benefit Systems Inc

Remote case manager responsible for reviewing clinicals and claims, developing and implementing maternity care plans, coordinating with members, vendors, CMS, and clinical teams, documenting outcomes and cost savings, and performing administrative tasks to support enhanced case management.

Sell health benefits solutions by building broker relationships, managing negotiations and renewals, processing RFPs, conducting presentations and open enrollments, and providing routine account service for self-funded plans.

Execute end-to-end group medical premium billing using QicLink: import/validate billing files, generate/distribute invoices, reconcile discrepancies, set up accounts, audit configurations, maintain reporting (Excel/Access/Power BI), partner with AR/AP/Eligibility/Client Services, perform root-cause analysis, and ensure internal controls and billing accuracy.

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.

Deliver and support inbound/outbound EDI (ANSI X12-834) and claims file implementations, perform EDI mapping and testing, monitor file processing, troubleshoot data discrepancies, coordinate cross-functional stakeholders, and maintain data integration documentation and quality controls.

Prepare, file, and monitor individual stop loss (specific) medical claims for reimbursement; follow up with carriers, handle appeals for denied/reduced reimbursements, retain documentation, train team members, and coordinate priority/high-dollar claims.

Reprice medical and dental claims (CMS1500, UB04) using multiple applications and PPO networks, then key adjusted claims into QicLink with 99%+ accuracy. Communicate with teams to resolve issues and perform other assigned duties. Remote role requiring high-speed internet; high school diploma and data entry experience required. Proficiency with Word, Excel, Outlook; Access and HCFA/UB92 experience preferred.

Manage a portfolio of self-funded group health plan clients, acting as liaison between clients/brokers and internal teams. Lead implementations, present renewals and employee trainings, ensure ACA compliance, produce and analyze reporting, resolve claims and billing issues, and drive client satisfaction and cross-selling.

Maintain and develop healthcare software in an agile environment. Design, code, debug, test, and release enhancements; use TDD and CI/CD; build/maintain RESTful APIs and SQL Server stored procedures. Collaborate with QA and managers, adhere to HIPAA/HITECH privacy and security rules, and support automation testing and troubleshooting.

Support resolution of department escalations by collaborating with internal teams, vendors, and external partners. Manage vendor relationships, document and improve processes, provide training, and act as departmental spokesperson under Senior Liaison guidance. Serve as backup to the Senior Case Management Liaison and perform other duties as assigned.

Manage a book of self-funded group health plan clients as the primary day-to-day resource. Handle client and broker communications, ACA compliance, reporting, renewals, open enrollment project management, presentations, issue resolution, plan performance reviews, and cross-selling of Allied solutions to ensure client satisfaction and retention.

Manage setup and daily operations of eligibility technology platforms including EDI and web portals. Configure group setups, process changes/renewals/open enrollment, review audit reports, perform QA testing, provide client training/support, ensure data integrity, troubleshoot and escalate issues, and maintain ongoing eligibility operations.

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.

Lead and coordinate implementation of new products, services, compliance initiatives, and vendor relationships. Create and maintain project plans, timelines, documentation, and reports; communicate with cross-functional teams and stakeholders; manage vendor selection and relationships; identify and resolve project roadblocks; recommend process improvements and ensure quality and customer experience. Remote role requiring reliable high-speed internet.

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.

Administer, configure, and improve business applications while partnering with stakeholders, IT, and vendors. Manage enhancements, UAT, integrations, support tickets, vendor relationships, documentation, and application performance monitoring to ensure operational effectiveness.

Lead enterprise architecture strategy and hands-on design, documentation, and implementation of Microsoft-stack, cloud-based and containerized solutions. Collaborate with technical leaders, define roadmaps and transition plans, ensure SDLC/CI/CD/API and data engineering best practices, enforce security and HIPAA compliance, implement monitoring/alerting and escalation processes, and train development teams.

Manage enhanced case management for members with chronic conditions by reviewing clinicals and claims, developing and implementing care plans, coordinating with vendors, CMS, clinicians and clients, documenting outcomes and cost savings, and performing administrative tasks to optimize internal 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.