Allied Benefit Systems

Advocate

• Respond to inbound member inquiries via telephone and email regarding provider access, plan benefits, claims, and balance billing concerns
• Conduct outbound outreach to providers to confirm plan acceptance and gather required information
• Support balance billing resolution and facilitate member access to care
• Educate members, providers, employers, brokers, and internal partners on plan design, coverage, tools, and resources
• Obtain, review, and document information related to provider access issues and balance billing concerns
• Coordinate signed HIPAA authorizations when required
• Serve as a liaison between members, providers, and internal teams
• Document interactions, actions, and outcomes in applicable systems
• Meet productivity, quality, and customer service performance metrics
• Collaborate with Client Service team members and leadership on projects, ad hoc reporting, and process support
• Escalate complex access or resolution issues to leadership
• Perform other duties as assigned

Member Advocate

General

• Organize and complete all claim appeals received in the Appeal Department
• Review appeals and supporting documentation
• Review Summary Plan Documents to determine appeal validity
• Compose appeal response letters when necessary
• Communicate with other departments and clients when necessary
• Document appeal status and outcomes in the QicLink system and database
• Email claims examiners and other units when necessary
• Prioritize incoming referrals and complete tasks timely
• Perform other related duties as assigned

Appeals Specialist

Network Engineer

• Implement appropriate networks/vendors for Allied clients
• Submit new setup paperwork
• Maintain, update, and test new networks to ensure they meet client needs
• Work with Implementation Managers and Coordinators to assign networks properly
• Coordinate with external network contacts on network interactions, issues, and standard processes
• Implement and maintain networks/vendors for new business, renewals, and terminations
• Maintain relationships with networks/vendors
• Communicate network-related updates internally and externally
• Respond to and assist the implementation team with network issues and questions
• Resolve escalated issues and inform appropriate Allied teams
• Develop efficient tracking and ad hoc reporting
• Audit completed tasks for accuracy
• Maintain client files and history
• Perform other duties as assigned

Member Advocate

Appeals Specialist

Network Administrator