Allied Benefit Systems · 1 day ago
Claims Negotiator I
United States
Full-time
Remote
Senior Level
$48K/yr - $52K/yr
5+ years expAllied Benefit Systems is seeking a Claims Negotiator I to negotiate out-of-network claim payments with providers on behalf of group health plans. The role involves reviewing health care claims for reasonableness, negotiating discounts with providers, and ensuring compliance with privacy laws.
Health CareInsuranceWellness
Responsibilities
Independently review and analyze health care claims for: 1) reasonableness of cost; 2) medically unnecessary treatment by physicians and hospitals; and 3) fraud
Determine whether a health plan provides benefits in connection with the claim submitted and the level of benefits to be paid to the provider
Contact providers to negotiate discounts
Reprice claims to the applicable Medicare rate
Log negotiated claims into the Access database and create weekly summary reports
Review and understand the terms and conditions of each client’s customized plans
Understand and comply with all applicable privacy and security laws, including but not limited to HIPAA, and any regulations promulgated thereto
Request, review and analyze any physician notes, hospital records or police reports
Consult with other entities who can offer additional evaluation of a claim
Process claims in the QicLink System
Review, analyze and add applicable notes to the QicLink System
Document all information gathered in available systems as needed, including the QicLink System and alliedbenefit.com
Review billed procedure and diagnosis codes on claims for billing irregularities
Analyze claims for billing inconsistencies
Review and analyze specific procedure and diagnosis codes for medical necessity
Authorize payment, partial payment or denial of claim based upon individual investigation and analysis
Review Suspended Claim Reports and follow up on open issues
Assist and support other team members as needed and when requested
Attend continuing education classes as required, including but not limited to HIPAA training
Performs other related duties as assigned
Qualification
Required
Bachelor's degree or equivalent work experience required
A minimum of 5 years of medical claims analysis experience required
Must have strong analytical skills
Must have knowledge of computer systems and CPT and ICD-9 coding terminology
Benefits
Medical
Dental
Vision
Life & Disability Insurance
Generous Paid Time Off
Tuition Reimbursement
EAP
Technology Stipend
Company
Allied Benefit Systems
Allied offers insurance products, self-insurance solutions, custom insurance and healthcare solutions to the individuals and organizations.
501-1000 employees
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
Stone Point Capital
2021-02-18Private Equity
Leadership Team
D
Dina H. Tank
Senior Vice President of Sales, Western Region
Recent News
2025-06-04
2025-06-03
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