Senior Claims Adjustment Analyst (Remote)

About the Role

The Senior RRT Analyst will review incoming referrals daily to determine priority and distribute team assignments. They will run reports from Allied’s website for special projects to determine adjustments needed and assign accordingly, as well as provide training to the team. The role also involves managing Blue Cross Blue Shield (BCBS) and Anthem adjustments.

Responsibilities

• Work with other departments to determine the appropriateness of an RRT referral.
• Manage the BCBS and Anthem process, including adjustments and closing claims in the BCBS systems.
• Track and handle projects in a timely manner.
• Update member accumulators and complete adjustments as necessary.
• Maintain department workflows for RRT processes.
• Handle tasks assigned to RRT, such as high-dollar split claims, repricing adjustments, and group exception referrals.
• Run web reports for special projects.
• Support other units within Claim Operations.
• Support the Refund process when needed.
• Perform other related duties as assigned.

Requirements

• High school diploma or equivalent required.
• 5+ years of comprehensive experience with adjustment processing.
• Proficiency in Microsoft Word and Excel; ability to learn other data systems.

Skills

• Accountability
• Analytical Thinking
• Collaboration
• Communication
• Customer Focus
• Functional Expertise
• Initiative

Work Environment

This is a remote role. Allied supports a remote-friendly culture with flexibility to work from home. To ensure a smooth experience, a reliable internet connection with speeds of at least 100Mbps download/25Mbps upload (via cable broadband or fiber optic) is required.

Benefits

• Medical, Dental, Vision, Life, and Disability Insurance
• Generous Paid Time Off
• Tuition Reimbursement
• Employee Assistance Program (EAP)
• Technology Stipend