Allied Benefit Systems

General

• Responsible for the organization and completion of all claim appeals received in the Appeal Department.
• Reviewing appeal and supporting documentation
• Reviewing Summary Plan Documents to determine validity of appeal
• Composing appeal response letters when necessary
• Communicating with other departments and clients when necessary
• Documenting the QicLink system and database with appeal status and outcome
• Emailing claims examiners and other units when necessary
• Prioritize incoming referrals to complete all tasks timely
• Performs other related duties as assigned

Healthcare Appeals Specialist

Accounts Payable

• Process and reconcile accounts receivable and accounts payable transactions, ensuring accuracy, completeness, and timely resolution of discrepancies.
• Apply and reconcile cash receipts, client funding, vendor payments, and administrative fee transactions.
• Monitor and reconcile financial activity across billing, funding, eligibility, and claims-related systems.
• Research, investigate, and resolve complex payment, billing, and reconciliation issues.
• Support premium billing, client funding, and financial transaction processes for multiple clients and employer groups.
• Collaborate with Billing, Broker Operations, Account Services, and external partners to ensure accurate financial processing and account maintenance.
• Maintain financial records and supporting documentation in accordance with internal controls, audit requirements, and compliance standards.
• Analyze transaction data and prepare reports to support operational and financial decision-making.
• Identify process inefficiencies, perform root cause analysis, and implement improvements to enhance accuracy and operational effectiveness.
• Utilize financial systems and reporting tools, including Excel and emerging technologies, to streamline workflows and improve reporting capabilities.
• Serve as a subject matter expert for AR/AP processes and provide guidance on financial transactions, reconciliations, and system-related issues.
• Manage multiple priorities and deadlines while maintaining a high level of customer service and transaction accuracy.

Senior AP/AR Specialist

Operations

• Coordinate the implementation of new products, services, compliance initiatives, and vendor relationships from inception to completion
• Develop and maintain detailed project plans, track progress, and ensure that all milestones are met
• Collaborate and effectively communicate with cross-functional teams to ensure alignment on project deliverables and timelines
• Assist with the evaluation, selection, and management of vendors, ensuring they meet our quality and compliance standards
• Develop and maintain strong vendor relationships to optimize partnerships
• Assist with the development and maintenance of accurate records, project plans, and documentation, and reports
• Provide regular updates to stakeholders on project status and key metrics
• Provide feedback and recommendations on process improvement for successful project implementations
• Promptly identify and address any issues or roadblocks that may impede project success and assist with developing and implementing effective solutions in a timely manner
• Ensure that all implemented products, services, and initiatives meet our quality standards and provide an exceptional customer experience

Healthcare Appeals Specialist

Senior AP/AR Specialist

Project Leader, Operations Implementation