This one’s for people who don’t panic when they see 837/835 files. You’re basically the “claims traffic controller” making sure data is clean, errors get fixed fast, and Anthem/Blue Shield aren’t sitting on inventory because something broke upstream.
About Allied Benefit Systems
Allied supports healthcare benefits administration and claims operations. This role sits in Operations and works closely with internal EDI/Claims teams plus major health plan partners.
Schedule
- Full time
- Fully remote
- Internet requirement: cable/fiber with at least 100 Mbps download / 25 Mbps upload
What You’ll Do
- Analyze and validate 837 (institutional/professional) and 835 (remittance advice) files
- Spot discrepancies, formatting issues, and data integrity problems
- Partner with EDI, Claims, and other internal teams to resolve file errors and escalations
- Process file adjustments and resolve issues using vendor portals/tools
- Monitor daily operational reports: claims processing, payment reconciliation, error tracking
- Monitor inventory reports from health plan partners to meet turnaround timeframes
- Identify trends/insights to improve performance and support compliance
- Act as primary point of contact between Claims Ops and health plans (Anthem, Blue Shield)
- Run regular status meetings, escalate issues, and track action items
- Recommend workflow/reporting enhancements
- Support implementations that impact claims data exchange
What You Need
- Bachelor’s degree in a related field or equivalent work experience
- 3+ years in healthcare claims processing/claims analysis, ideally with 837/835 exposure
- Strong understanding of HIPAA transaction standards and EDI formats
- Experience with TPAs and major health plans (Anthem/Blue Shield preferred)
- Strong Excel skills (data visualization tools are a plus)
- Organized, detail-obsessed, able to juggle multiple priorities
- Familiarity with claims adjudication systems
Benefits
- Medical, dental, vision, life & disability insurance
- Generous PTO
- Tuition reimbursement
- EAP
- Technology stipend
Quick gut-check (because I’m not gonna let you waste time):
If you can confidently speak to how an 837 becomes a paid claim + how the 835 explains the payment, and you’ve actually investigated file errors (not just “worked claims”), this is a strong match. If you’ve never touched EDI files and only worked denial follow-up, this might be a stretch.
Happy Hunting,
~Two Chicks…