Negotiate out-of-network claim payments and help group health plans control costs without sacrificing compliance. If you’re strong in claims analysis, coding, and provider negotiation, this role is a solid remote lane with real investigative work.
About Allied Benefit Systems
Allied Benefit Systems supports employers and members through claims and benefits administration services. Their claims teams focus on accurate analysis, cost control, and compliant processing across customized health plans.
Schedule
- Full-time, fully remote
- Salary range: $48,000–$52,000
- Internet requirement: cable broadband or fiber with at least 100 Mbps download / 25 Mbps upload
What You’ll Do
- Analyze healthcare claims for cost reasonableness, medical necessity, and potential fraud
- Determine benefit eligibility and appropriate payment levels based on plan terms
- Contact providers to negotiate discounts on out-of-network claims
- Reprice claims to applicable Medicare rates when appropriate
- Identify billing irregularities by reviewing procedure and diagnosis codes (CPT/ICD)
- Review and request supporting documentation (physician notes, hospital records, police reports) as needed
- Consult with external entities for additional claim evaluation when appropriate
- Process and document claims in QicLink and related systems, adding clear investigative notes
- Log negotiated claims in an Access database and prepare weekly summary reports
- Review Suspended Claim Reports and follow up on open issues
- Authorize payment, partial payment, or denial based on analysis and investigation
- Support teammates as needed and complete required continuing education (including HIPAA)
What You Need
- Bachelor’s degree or equivalent work experience
- 5+ years of medical claims analysis experience
- Strong analytical skills and attention to detail
- Knowledge of CPT and ICD coding terminology (posting mentions ICD-9)
- Comfort working across multiple systems and databases
Benefits
- Medical, dental, and vision insurance
- Life & disability insurance
- Generous paid time off (PTO)
- Tuition reimbursement
- Employee Assistance Program (EAP)
- Technology stipend
Quick gut-check: they call this “Negotiator I,” but they want 5+ years of claims analysis. That’s not entry-level. If you’ve got the experience, you’ll be competitive. If you don’t, this one will likely auto-screen you out.
Happy Hunting,
~Two Chicks…