Medical Claims Processor

Would you like to be part of a growing national healthcare solutions company? Are you looking to positively affect thousands of lives each day via health benefits? Are you looking for a processing role with growth potential?

We are hiring for a Medical Claims Processor to join our team.

What you will be doing?

The Assistant Claim Specialist is an entry level position for claim processing. This person will use independent judgement and discretion to review, analyze, and make determinations regarding payment, partial payment, or denial of medical and dental claims, as well as various types of invoices, based upon specific knowledge and application of each client’s customized plan(s).

ESSENTIAL FUNCTIONS

• Process Medical and Dental claims as well as invoices, in the QicLink system.
• Read, analyze, understand, and ensure compliance with clients’ customized plans
• Learn, adhere to, and apply all applicable privacy and security laws, including but not limited to HIPAA, HITECH and any regulations promulgated thereto.
• Independently review, analyze and make determinations of claims for: 1) reasonableness of cost; 2) unnecessary treatment by physician and hospitals; and 3) fraud.
• Review, analyze and add applicable notes in the QicLink system.
• Review billed procedure and diagnosis codes on claims for billing irregularities.
• Analyze claims for billing inconsistencies and medical necessity.
• Authorize payment, partial payment or denial of claim based upon individual investigation and analysis.
• Review Workflow Manager daily to document and release pended claims, if applicable.
• Review Pend and Suspend claim reports to finalize all claim determinations timely.
• Assist and support other Claim Specialists as needed and when requested.
• Attend continuing education classes as required, including but not limited to HIPAA training.

SKILLS & ABILITIES

All applicants must have strong analytical skills and knowledge of computer systems. Continuing education in all areas affecting group health and welfare plans is required. Applicants must demonstrate the desire to assist the Team with exceeding all established goals.

EXPERIENCE

Applicants must have a minimum of two years of medical claims processing experience. Prior experience with dental and vision processing is preferred but not required. Applicants must also have knowledge of CPT and ICD-10 coding.

EDUCATION

High School Graduate

WORK ENVIRONMENT

Remote

Work Schedule

Flexible start, full-time hours

Who we are

Allied is a national healthcare solutions company that supports healthy workplace cultures.

What we do

We are problem-solvers, innovators, and collaborators. Our purpose is to work with employers to take care of their employees and their families every day – and it all starts with the Allied family.

What’s in it for you?

Allied supports an inclusive culture focused on developing employees to succeed, innovate & impact the community.

Here’s how we do it

Training and Development: Allied offers tailored learning and development curriculums for all employees and a Learning Management Database with thousands of courses for professional and personal development.

Career Mobility: Growth opportunities are endless at Allied. In 2021 alone, one in five employees had a job change. 75% of these job changes were promotions!

Employee Engagement: We pride ourselves on employee engagement! With our recognition program, employees recognize their colleagues monthly or donate to charities with cash rewards. Allied has a dedicated committee planning monthly engagement activities to create endless opportunities to get to know your peers and destress in this new remote world.

Employee Feedback: We regularly survey our employees throughout the year to seek continuous feedback, ideas and suggestions on new initiatives.

Community Outreach: We have dedicated committees focused on fundraising efforts supporting our employees and their families, furthering education goals and providing funds for charitable organizations outside of Allied.