Allied Benefit Systems

Account Executive

• Manage the renewal processes, collaborating with account management and underwriting for renewals on the assigned book of business.
• Position and showcase products, rates, stop loss, and expanded product portfolios to increase sales and maximize revenue.
• Process receipts and prepare Requests for Proposals (RFPs) to send to underwriting and stop loss vendors.
• Perform routine operational tasks associated with evaluating an RFP (e.g., disruption).
• Act as a client-facing representative, providing support during open enrollments, independently conducting open enrollment presentations, and effectively addressing member issues.
• Assist in resolving routine problems (i.e., underwriting, reporting, billing, employer, and member concerns, etc.) by working with the appropriate departments and the Account Manager to ensure resolution.
• Help facilitate the renewal of existing cases by managing claim reviews, stop loss marketing, and setting service level expectations.
• Produce and analyze Ad Hoc reporting when requested from the client/broker/Account Executive.
• Other duties as assigned.

Associate Client Executive

Solutions Engineer

• Develop and drive the overall architecture strategy with hands-on involvement in design, documentation, and implementation.
• Collaborating with tech teams and departments leads to deliver complex projects which may involve multiple systems.
• Analyze, document, refine, and maintain architectures that are developed within the team.
• Work closely with the IT operations team to request and refine hardware requirements for existing and new systems.
• Create strategy and transition plans to deliver projects on time.
• Take ownership of executing technology roadmap to transition existing architecture to new, stable design.
• Work closely with the Security team to tighten any security issues discovered in infrastructure.
• Meet Allied’s expectations for productivity, quality, and goal accomplishment.
• Working closely with the department lead to prioritize and strategize.
• Adhere to, and apply all applicable privacy and security laws, including but not limited to HIPAA, HITECH and any regulations promulgated thereto.

Principal Solutions Architect

Claims Specialist

• Prepare and file medical stop loss claims for reimbursement with stop loss carriers for aggregate coverage
• Follow up with the various carriers to ensure reimbursements are received in time and in full
• Appeals of denied and reduced claim reimbursements
• Retain the appropriate documentation needed to support the reimbursement request
• Compile and submit claim reports and the necessary documentation to file a stop loss claim
• Frequently monitor the status of claims assigned and follow up with stop loss carriers
• Answer questions and requests from stop loss carriers for additional information
• Communicate with other internal departments to resolve claim issues
• Manage time to file aggregate accommodation, level funded and/or final claim submissions per contract stipulations
• Audit the aggregate positions, tracking the funding balance and updated reporting monthly
• Prepare both the year end and monthly accommodation aggregate claim filings upon reconciliation of the claim activity

Stop Loss Claims Specialist I – Aggregate

Account Manager

• Act as the liaison between the employer and broker, Client Executive, and various Allied departments involved in administering self funded group health plans
• Provide communication regarding industry and legislative updates and ACA compliance
• Manage and resolve escalated employee issues
• Conduct quarterly meetings to review plan performance, build client relationships, and ensure overall satisfaction leading to client retention
• Communicate changes internally regarding benefit plan design, financial information, and vendor partner changes
• Prepare and host employee presentations, employer portal training, and executive summary report reviews
• Troubleshoot, identify, and improve internal processes with various Allied departments
• Produce and analyze ad hoc reporting when requested from a client, broker, or Client Executive
• Help facilitate the renewal of existing cases by managing claims, producing updated plan documents, and project managing open enrollment for current employer groups
• Cross sell various Allied solutions to existing clients

Case Coordinator

• An ECM Coordinator III supports department staff with administrative tasks related to a member’s medical condition(s), department case work, communication with internal and external stakeholders, and manage audits.
• This role will engage with members to offer support and resources related to their medical condition(s) through Allied Care.
• Facilitate reviews, referrals, and outreach for referral-based proprietary strategies as well as engaging with members across Medical Management products.
• Document all engagement accurately and concisely within the Microsoft Customer Relationship Management (CRM) system.
• Manage escalated and time sensitive case management questions received from members, broker relationships, and internal and external Allied stakeholders.
• Collaborate with strategic vendor partners to provide supportive services and support to members.
• Lead and facilitate claims auditing in conjunction with ECM Coordinators.

Case Management Coordinator III

General

• Assists with the resolutions department escalation by collaborating with various internal departments and vendors.
• Assists with the management of vendor relationships and associated process improvements.
• Acts as a spokesperson for the department under the guidance of the Senior Liaison.
• Effectively communicates and collaborates with external business partners and internal teams.
• Documents complex systems and processes.
• Provides guidance on documentation of all process, procedure, and workflows and enhancements.
• Perform training to internal staff and external clients and vendors as needed.
• Back-up for Senior Case Management Liaison.

Case Management Liaison

Manager

• Review clinicals, claims and baseline case information for health scenarios such as Behavioral, Wellness, and Specialty Prescription, Maternity etc.
• Develop strategic, initiative care plans to support members with varying health scenarios by connecting them to specialized vendor partners and Allied Care Clinicians that can facilitate the needs of the member.
• Implement the care plan by coordinating with the member, client, Allied staff and/or the various specialized vendor partners.
• Work closely with the Clinical Case Management team and other Case Managers to obtain clinical information needed to support the care plan.
• Communicate with (CMS) to obtain essential member information.
• Facilitate and maintain prescription drug vendor relationships, negotiate pricing as needed, manage member set-up, and provide on-going support.
• Document the impact of the casework to highlight cost savings and the improvement of member health outcomes as a result of implanting a plan of care.
• Perform assorted weekly and monthly administrative tasks.
• Act as the liaison between the client/broker/member and Allied Executives and Various Departments.
• Troubleshoot, identify, and collaborate to optimize internal processes within Enhanced Case Management and the various Allied departments.
• Other duties as assigned.

Healthcare Case Manager, Complex Care

Accounts Payable

• Ensure payments are collected on time
• Verify and record transactions
• Resolve account discrepancies
• Complete weekly Payables transactions using QicLink
• Research and resolve payment discrepancies
• Maintain account receivables records
• Contact clients via email

AP/AR Specialist

Engineering Manager

• Provide leadership for design and implementation of software architecture
• Manage internal application development
• Set up reliable and scalable platforms
• Define, Articulate and Execute web development strategies
• Provide hands-on management and individualized support to software engineers
• Influence technology strategy and drive data initiatives for the department
• Drive data and systems architecture planning
• Develop technical roadmaps and lead prioritization of technical investments
• Closely interact with Directory of Database Engineering and Director of Solution Architecture
• Partner with peer leaders within Product, Analytics, and Engineering
• Advise resource planning, personnel decisions, and team structures
• Hire and onboard new database engineers
• Lead, coach, motivate, and develop software engineers
• Clearly communicate expectations and provide training, resources, and information for success

Manager, Software Engineering

Care Coordinator

• Assists with the resolutions department escalation by collaborating with various internal departments and vendors.
• Assists with the management of vendor relationships and associated process improvements.
• Acts as a spokesperson for the department under the guidance of the Senior Liaison.
• Effectively communicates and collaborates with external business partners and internal teams.
• Documents complex systems and processes.
• Provides guidance on documentation of all process, procedure, and workflows and enhancements.
• Perform training to internal staff and external clients and vendors as needed.
• Back-up for Senior Case Management Liaison.
• Other duties as assigned

Autism Care Coordinator

• Act as the liaison between the employer and broker, Client Executive, and various Allied departments involved in administering self funded group health plans
• Provide communication regarding industry and legislative updates and ACA compliance
• Manage and resolve escalated employee issues
• Conduct quarterly meetings to review plan performance, build client relationships, and ensure overall satisfaction leading to client retention
• Communicate changes internally regarding benefit plan design, financial information, and vendor partner changes
• Prepare and host employee presentations, employer portal training, and executive summary report reviews
• Troubleshoot, identify, and improve internal processes with various Allied departments
• Produce and analyze ad hoc reporting when requested from a client, broker, or Client Executive
• Help facilitate the renewal of existing cases by managing claims, producing updated plan documents, and project managing open enrollment for current employer groups
• Cross sell various Allied solutions to existing clients
• Other duties as assigned

Bilingual Account Manager – English/Spanish

Pharmacist

• Conduct comprehensive clinical assessments to identify member needs and opportunities for improved outcomes
• Collaborate with providers and care teams to develop individualized care plans
• Monitor treatment progress and intervene when gaps in care or compliance are identified
• Establish trusting relationships with members through proactive outreach
• Address barriers to treatment adherence
• Partner with internal teams to enhance member experience and health results

Enhanced Case Management Pharmacist

Backend Engineer

• Design, develop, and maintain backend services, APIs, and business logic
• Collaborate with front-end engineers, product partners, and other stakeholders
• Participate in roadmap execution that balances feature delivery with backend health
• Provide technical guidance to junior developers
• Participate in code reviews to ensure solutions align with established engineering standards

Senior Software Engineer – Backend

• Manage high volumes of inbound and outbound member and provider calls, CRM-routed requests, emails, and digital submissions; validate account and eligibility details; and document all interactions and actions taken in accordance with internal quality standards.
• Enter, update, and verify member, provider, and employer-group information across CRM and benefits administration systems; maintain accurate call logs and documentation.
• Confirm eligibility, coverage levels, plan rules, and benefit limitations for members and providers; interpret plan documents to determine what services are covered.
• Review claim adjudication outcomes, explain payment decisions, request claim adjustments, and validate supporting documentation such as EOBs, timely filing, and coordination of benefits.
• Resolve member and provider questions related to benefits, claims, authorizations, billing, and network participation.
• Troubleshoot issues using internal knowledge bases and system tools.
• Serve as a liaison between the contact center and claims, eligibility, provider relations, and medical management teams to resolve escalated issues and ensure timely follow-through.
• Maintain detailed records of all interactions, ensure HIPAA compliance, and follow established workflows and regulatory guidelines.
• Assist members and providers with navigating the online portal, mobile app, coverage verification tools, and digital resources.
• Conduct provider and network searches, assist with PPO and reference-based pricing networks, and guide callers in locating in-network facilities or verifying provider eligibility.
• Analyze incoming requests, prep forms for scanning and routing route items to the appropriate operational teams. Fulfill faxes as needed.
• Prepare routine reports, track service issues, document trends, and support operational audits or quality reviews.
• Complete all assigned tasks by end of day, meet productivity and quality metrics, and support the overall efficiency of the contact center.
• Identify process gaps, recommend improvements, and act as a subject matter expert to support team development and operational excellence.

Clerical Support Coordinator

Product Analyst

• Identify, assess, and track the progress of product-related requests
• Collaborate closely with leadership and other members of the product management team on our team’s priorities
• Research and gather information necessary to assist with responses to product inquiries
• Assist in creating, updating, and maintaining product documentation
• Works with product leadership to establish structure for product documentation and organization of product portfolio
• Assist in producing and maintaining product training materials – including, but not limited to, external user guides, product descriptions, internal reference guides
• Support our coordination with marketing on the creation of product collateral
• Collaborate and develop relationships with internal teams including operations, sales, account management, marketing, and others
• Help assess new product opportunities and partnerships, as needed
• Support product management team with initiatives and special projects
• Performs other related duties as assigned