[Hiring] Medical Benefits & Case Management Specialist @Allied Benefit Systems

Role Description

The Case Management Administrator is responsible for managing complex case management scenarios involving members with significant medical conditions, including organ transplant cases. This role coordinates medical benefits administration, vendor relationships, documentation, and escalated issue resolution to support accurate claims processing and positive member outcomes. Success in this role requires strong healthcare knowledge, problem solving skills, and the ability to collaborate effectively with internal and external stakeholders.

• Assess, monitor, and maintain a caseload of members experiencing complex medical conditions
• Coordinate and support vendor contracting related to organ transplant scenarios, including but not limited to stem cell transplants
• Manage and support vendor relationships and associated workflow expectations such as claims processing, appeals, and invoicing
• Maintain system documentation for transplant scenarios, pharmacy medications, and escalated reviews
• Resolve department escalation by collaborating with various internal departments and vendors
• Collaborate with department team members, Case Management Liaisons, and the Senior Case Management Administrator on complex member scenarios, escalations, client renewals
• Collaborate on documentation of communication procedures and workflows
• Notify the Case Management Training & Quality Auditor of updates to systems and processes
• Support training to internal staff as needed when appropriate
• Other duties as assigned

Qualifications

• Bachelor's degree in a relevant field or equivalent work experience, preferred
• Minimum 2 years of experience managing complex case management scenarios, required
• Must have 2 years of experience in medical benefits, health insurance, healthcare administration, or a related field, including knowledge of claims processing and healthcare operations, required
• Comfortable with advanced medical terminology
• Experience with organ transplant cases and/or transplant care coordination preferred
• Strong communication, collaboration, and problem solving skills
• Intermediate proficiency with Microsoft Office Suite

Requirements

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

Physical Demands

• This is a standard desk role requiring extended sitting and computer work

Work Environment

• Remote

Benefits

• Competitive Benefit Package including, but not limited to:
• Medical, Dental, Vision, Life and Disability Insurance
• Generous Paid Time Off
• Tuition Reimbursement
• EAP
• Technology Stipend