Senior Claims Adjustment Analyst

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Evaluate incoming referrals on a daily basis to establish priority and allocate team assignments.

• Generate reports from Allied’s website for special departmental projects.

• Identify necessary adjustments and delegate tasks accordingly.

• Provide training and development for the team as required.

• Oversee Blue Cross Blue Shield and Anthem adjustments.

• Collaborate with other departments to assess the suitability of RRT referrals.

• Manage the BCBS and Anthem process, including adjustments and the closure of claims within BCBS systems.

• Monitor and execute projects in a timely manner.

• Update member accumulators and finalize adjustments.

• Maintain departmental workflows for RRT processes.

• Manage high-value split claims, repricing adjustments, and group exception referrals.

• Provide support to other divisions within Claim Operations.

• Assist with the refund process as necessary.

• Carry out additional related duties as assigned.

⛳️ Requirements

• High school diploma or equivalent is mandatory.

• A minimum of 5 years of extensive experience in adjustment processing.

• Strong proficiency in Microsoft Word and Excel.

• Capability to quickly learn other data systems.

• Ability to sit for extended periods and engage in computer work.

• Access to cable broadband or fiber optic internet service with a minimum of 100Mbps download and 25Mbps upload speeds.

🏝️ Benefits

• Medical Insurance

• Dental Insurance

• Vision Insurance

• Life Insurance

• Disability Insurance

• Generous Paid Time Off

• Tuition Reimbursement

• Employee Assistance Program (EAP)

• Technology Stipend

• Flexible work-from-home arrangement