Product Operations Liaison

Job Description:

POSITION SUMMARY

Interact between our internal/external teams and the client to offer the best customer service through claim review and investigation, replying via email.  Execute investigation of multiple claim functions, including but not limited to the management and facilitation of HRA RX claim reviews, RRTs, claim processing and special claim requests. 

ESSENTIAL FUNCTIONS

• Mediate between our members and our administrative team. 
• Use Outlook and external programs to communicate with the member or agent the status of all open claims.
• Advocate for our members through investigation of open claims to ensure timely processing of payments.
• Push failed claims over $10K through the IPAO process until completed.
• Understand the role of the Administrator, and back the Administrator team up when needed.
• Executes effective resolutions on claim issues and ensures that the appropriate Allied teams are informed, handles claim escalations, and sees through to completion.
• Processes fee claims for Case Management, Enhanced Case Management, HRA Pharmacy claims and various other vendor fee.
• Demonstrates strength and understanding of all workflows and business processes to execute the overall service strategy for BPO Clients.
• Fosters a sense of urgency and commitment to achieve goals resulting in the ability to influence the organization to meet and exceed customer expectations.
• Will own responsibility for and facilitate communications as stated above, handle escalations and oversee assist in various ad hoc projects as assigned.
• Perform other duties as assigned.

EDUCATION

• Bachelor’s degree or equivalent work experience, required

EXPERIENCE AND SKILLS

• 2+  years experience in an administrative or data entry role required
• Group Health Insurance/Benefits experience preferred
• Experience working with medical claims a plus
• Excellent verbal and written communication skills.
• Excellent organizational skills and attention to detail.
• Excellent time management skills with a proven ability to meet deadlines.
• Strong analytical and problem-solving skills.
• Ability to prioritize tasks and to delegate them when appropriate.
• Ability to function well in a high-paced and at times stressful environment.
• Proficient Microsoft Office Suite or related software.

POSITION COMPETENCIES 

• Communication
• Customer Focus
• Accountability
• Functional/Technical Job Skills

PHYSICAL DEMANDS 

• This is a standard desk role – long periods of sitting and working on a computer are required. 

WORK ENVIRONMENT

• Remote 

The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate. 

Compensation is not limited to base salary.  Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life & Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.

Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time.  All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process.  It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.