Claims Analyst I

Allied National Inc., a member-focused health benefits administrator, seeks a Claims Analyst I to review and process level-funded group health claims. In this role, you will verify eligibility, interpret plan documents, calculate benefits, and ensure accurate, timely payments while controlling costs. You'll investigate discrepancies, resolve claim issues, and communicate clearly with brokers, employers, providers, and members. Working in a collaborative, service-driven team, you'll use claims systems and Excel, follow regulatory and privacy requirements, and help improve access to affordable healthcare with opportunities to grow your insurance expertise.

Responsibilities

• Review, analyze, and adjudicate group health insurance claims for accuracy and completeness

• Verify member eligibility, coverage, and benefits against plan documents and system records

• Calculate claim payments and member/provider responsibility according to plan rules and contracts

• Research and resolve claim discrepancies, denials, and appeals within service-level standards

• Communicate claim decisions and benefit details to brokers, employers, providers, and members

• Maintain detailed, accurate documentation and update claims systems and member records

• Ensure compliance with HIPAA, ERISA, and internal quality and privacy standards

• Collaborate with underwriting, customer service, and account management to support clients

• Identify claim trends, errors, or potential cost-savings and recommend process improvements

• Participate in training and cross-training to expand knowledge of products and regulations Required Skills

• Claims processing

• Health insurance benefits analysis

• Eligibility verification

• ICD/CPT/HCPCS coding familiarity

• Data entry and accuracy

• Claims adjudication systems (e.g., Facets or similar)

• Excel and basic reporting

• Regulatory knowledge (HIPAA, ERISA)

• Customer service and communication

• Problem solving and dispute resolution