Senior Claims Adjustment Analyst
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Senior Claims Adjustment Analyst managing referrals, workflows, and BCBS/Anthem claims adjustments for Allied Benefit Systems. Running reports, updating accumulators, and supporting Claim Operations.
Responsibilities:
- Review incoming referrals daily to determine priority and distribute team assignments
- Run reports from Allied’s website for departmental special projects
- Determine adjustments needed and assign work accordingly
- Provide training to the team as needed
- Manage Blue Cross Blue Shield and Anthem adjustments
- Work with other departments to determine the appropriateness of RRT referrals
- Manage the BCBS and Anthem process, including adjustments and closing claims in BCBS systems
- Track and handle projects timely
- Update member accumulators and complete adjustments
- Maintain department workflows for RRT processes
- Handle high-dollar split claims, repricing adjustments, and group exception referrals
- 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 easily learn other data systems
- Ability to work extended periods sitting and performing computer work
- Cable broadband or fiber optic internet service with at least 100Mbps download and 25Mbps upload
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
Similar Jobs
Senior Claims Refund Analyst
Senior Refund Analyst processing claims refunds for Allied Benefit Systems. Tracking overpayments, resolving refund appropriateness, and reporting processing errors remotely.
Mortgage Post Closing Quality Control Analyst
Post-closing quality control analyst auditing mortgage files for AmeriSave, an online mortgage lender. Reviewing compliance, insurance, disclosures, conditions, and trailing documents.
Mortgage Analyst
Condo Analyst supporting AmeriSave’s online mortgage lending and loan-closing operations. Managing project tasks, reviewing documents, and coordinating with underwriters, processors, vendors, and HOAs.
Senior HEDIS Quality & Audit Analyst
Senior HEDIS analyst leading healthcare quality audits and CMS submissions for Centene. Ensuring audit readiness, regulatory compliance, and accurate documentation for health plan operations.
Correspondent Analyst Intern
Correspondent Credit Analyst Intern supporting ARC lending and commercial loan teams at SouthState Bank. Preparing client proposals, sales materials, and Rate Conversion Agreements.
Member Appeals & Grievance Analyst – Level 2
Member appeals analyst resolving CMS-regulated cases for BCBST, Tennessee’s health benefit plan company. Investigating complaints, communicating outcomes, and ensuring timely regulatory compliance.
Real Estate Analyst
Real estate analyst guiding Arizona store site selection, market planning, and lease negotiations for Five Below, a trend-right value retailer. Supporting new-store growth, relocations, and real estate strategy across the assigned territory.
Senior Service Analyst – 12 Month Fixed Term Contract
Senior Service Analyst using SQL, Looker, and workforce-management insights at Monzo, a UK digital bank. Optimizing staffing, dashboards, reporting, automation, and incident response for customer operations.
Quality Analyst
Analista de Qualidade remoto na Spassu, empresa de tecnologia. Garantia de qualidade digital, testes e coordenação de múltiplos times ágeis.
Conflicts Analyst
Conflicts Analyst conducting legal conflict searches and matter intake for Butler Snow, a US law firm. Analyzing potential conflicts and supporting attorneys, leadership, and firm operations.
Conflicts Analyst
Conflicts Analyst conducting legal conflict searches and matter-intake reviews for Butler Snow, a U.S. law firm. Analyzing ethical issues and supporting attorneys, leadership, and firm personnel.
Conflicts Analyst
Conflicts Analyst conducting legal conflict searches and matter-intake reviews for Butler Snow LLP, a U.S. law firm. Supporting attorneys and leadership with accurate, compliant conflict resolution.
Conflicts Analyst
Conflicts Analyst conducting legal conflict searches and matter intake for Butler Snow, a US law firm. Reviewing ethical issues and supporting attorneys, staff, and firm leadership.
Innovation Analyst – Mid-level
Analista de Inovação gerenciando PoCs e acelerando startups soft tech e deep tech para grandes corporações. Facilitando sprints, validando hipóteses e conduzindo maturidade tecnológica e comercial até a continuidade contratual.
InfoSec Analyst II, Trust
InfoSec Analyst II improving compliance, customer assurance, and AI governance at Chainalysis, a blockchain intelligence platform. Managing SOC 2, ISO 27001, assessments, controls, and remediation.
Program Cost Control Analyst, Remote
Program Cost Control Analyst managing budgets, forecasts, billing, and financial reporting for HII’s defense technology programs. Supporting All-Domain Operations and collaborating with program and business-management teams.
Functional Analyst – International Trade
Analista Funcional de Comércio Exterior na Reply, multinacional italiana de TI. Traduzindo necessidades operacionais em requisitos e apoiando sistemas, projetos, testes e suporte.
Digital Analyst
Digital Analyst improving Best Buy Canada eCommerce conversion, loyalty, and customer experience. Building dashboards, analyzing web data, and designing A/B tests.
Data Measurement & Reporting Lead Analyst
Clinical analyst supporting Evernorth’s pharmacy, care, and benefit solutions through clinical modeling, reporting, and client program implementation. Partnering across business teams to improve operational controls, workflows, and client-specific clinical deliverables.
IT Applications Analyst, Healthcare Experience Preferred
IT Applications Analyst supporting enterprise applications for Liberty Dental Plan, a dental and healthcare services organization. Troubleshooting systems, analyzing SQL data, and coordinating vendors and stakeholders.