Medical Benefits & Case Management Specialist (Remote)

POSITION SUMMARY

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.

ESSENTIAL FUNCTIONS 

• 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

EDUCATION

• Bachelor's degree in a relevant field or equivalent work experience, preferred.

EXPERIENCE AND SKILLS

• 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.

POSITION COMPETENCIES

• 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 ENVIROMENT

• Remote

Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.

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 and 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.