Remote Healthcare Claims Analyst

Allied Benefit Systems, LLC; Chicago (IL); Remote; USD 45,000 - 55,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

Paid Time Off

Tuition Reimbursement

EAP

Job summary

Allied Benefit Systems, LLC is seeking a Healthcare Claims Examiner for a fully remote role. You will determine the proper payment of medical claims for group health plans and apply client-specific plan terms, HIPAA, and privacy requirements.

Responsibilities include reviewing claims for reasonableness and medical necessity, contacting providers to negotiate discounts, logging activity in QicLink/Access databases, and producing weekly summaries.

Qualifications

• 5+ years of medical claims analysis experience (including dental and vision)
• Strong analytical skills
• Knowledge of CPT and ICD-9 coding terminology
• Continuing education in all areas affecting group health plans is required.

Responsibilities

• Review and analyze health care claims for reasonableness and medical necessity.
• Authorize payment, partial payment or denial of claims after investigation.
• Log claims negotiated and create weekly summary reports.
• Review billed procedure and diagnosis codes for billing irregularities.
• Assist and support team members and participate in HIPAA training.

Skills

Analytical skills

CPT/ICD-9 coding

5+ years experience

Education

High school diploma

Tools

Access database

QicLink System

Job description

Allied Benefit Systems, LLC is seeking a Healthcare Claims Examiner for a fully remote role. You will determine the proper payment of medical claims for group health plans and apply client-specific plan terms, HIPAA, and privacy requirements.

Responsibilities include reviewing claims for reasonableness and medical necessity, contacting providers to negotiate discounts, logging activity in QicLink/Access databases, and producing weekly summaries.