Medical Benefits & Case Management Specialist (Remote)
Allied Benefit Systems•Chicago, IL
•$50,000 - $60,000•Remote
About The Position
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.
Requirements
- 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.
- Strong communication, collaboration, and problem solving skills.
- Intermediate proficiency with Microsoft Office Suite.
Nice To Haves
- Experience with organ transplant cases and/or transplant care coordination preferred.
Responsibilities
- 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
- Resolves 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
- Collaborates 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
Benefits
- Medical
- Dental
- Vision
- Life and Disability Insurance
- Generous Paid Time Off
- Tuition Reimbursement
- EAP
- Technology Stipend
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
