Claims Analyst

POSITION SUMMARY:

The Claims Analyst (RRT Anthem Liaison) will be responsible for handling all communications, adjustments, and closing out claims through various applications with our outside vendors, Blue Cross Blue Shield and Anthem.

ESSENTIAL FUNCTIONS:

• Review daily production reports and adjustment reports from Anthem to ensure claims and adjustments are closed within the designated turnaround time.
• Process all adjustment claims for Anthem and Blue Cross Blue Shield.
• Send adjustment requests to Anthem and Blue Cross Blue Shield.
• Assist with questions from other internal departments for both Anthem and Blue Cross Blue Shield.
• Review exception reports sent by Anthem.
• Close out any claims in the various Blue Cross Blue Shield applications.
• Work incentive reports monthly to ensure claims are closed.
• Review outbound reports daily for Blue Cross Blue Shield.
• Performs other related duties as assigned

EDUCATION:

• High School diploma or equivalent required

EXPERIENCE AND SKILLS:

• Minimum of 3 years medical claims processing experience required.
• Experience with the QicLink claims processing system preferred.
• Adjustment experience is required.
• Jointly Administered Arrangements (JAA) experience is preferred; however, it is not required.
• Applicant should be proficient in using the Excel and Word programs, have experience with or ability to learn Microsoft Access, and communicate effectively both orally and by email.

POSITION COMPETENCIES:

• Job Knowledge

• Time Management
• Accountability
• Communication
• Initiative
• Customer Focus

PHYSICAL DEMANDS:

• This is a standard desk role – long periods of sitting and working on a computer are required.

WORK ENVIRONMENT:

• Remote

Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.

The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life & Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.

Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.