Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. Our commitment and partnership means thinking beyond the typical solutions in the market – to do more for clients – and take them beyond the standard “Point A to Point B.” We have researched the most effective cost containment strategies and are driving down the cost of plans with innovative solutions such as, network and payment integrity, pharmacy benefits and care management. There are many companies with a mission. We are a mission with a company. Point C is looking for a detail-oriented and motivated Claims Examiner to join our team. In this role, you’ll be responsible for accurately processing medical claims while ensuring compliance with plan documents, policies, and industry regulations. The ideal candidate is analytical, organized, and experienced in self-funded or third-party administration environments. Primary Responsibilities - Adjudicate new claims and process adjustments, including denials upon receipt of additional information - Review and resolve appeals and subrogation/third-party liability cases - Manage individual inventory to ensure timely turnaround and production goals are met - Ensure claims are processed in accordance with stop loss contract terms - Respond to internal and external inquiries via email and other channels within established timeframes - Follow up on missing or incomplete information to ensure claims can be accurately processed - Maintain minimum production, financial, and procedural accuracy standards on a monthly basis Qualifications - Associate's degree preferred - Experience with Third Party Administrator (TPA) or self-funded claims administration preferred - At least 2+ years of experience in insurance claims processing required - Experience reviewing and finalizing claim payments for accuracy in accordance with plan policies - Ability to interpret and apply plan documents to ensure accurate claims adjudication - Demonstrated understanding of both claim review processes and underlying benefit plan design - Experience with HealthPac, El Dorado, Javelina, or VBA systems preferred - Working knowledge of CPT and ICD-10 coding - Basic understanding of medical terminology - Strong communication and customer service skills - Proficiency in Microsoft Office and general computer applications - Ability to maintain confidentiality and comply with all company policies and procedures - Able to work independently with minimal supervision - Ability to prioritize, multitask, and work overtime as needed Individual compensation will be commensurate with the candidate's experience and qualifications. Certain roles may be eligible for additional compensation, including bonuses, and merit increases. Additionally, certain roles have the opportunity to receive sales commissions that are based on the terms of the sales commission plan applicable to the role. Pay Transparency $18—$22 USD Benefits: - Comprehensive medical, dental, vision, and life insurance coverage - 401(k) retirement plan with employer match - Health Savings Account (HSA) & Flexible Spending Accounts (FSAs) - Paid time off (PTO) and disability leave - Employee Assistance Program (EAP) Equal Employment Opportunity: At Point C Health, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business—and our society—stronger. Point C Health is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.

• Investigate & Resolve Claims: Assess and resolve auto claims with moderate supervision, focusing on coverage, liability, and damages. • Judgment & Decision-Making: Use sound judgment to determine exposure and the best course of action. • Cost Control: Minimize claims costs and expenses while ensuring a positive experience for policyholders. • Collaboration: Interact extensively with various parties involved in the claim process. • Process Improvement: Identify and implement ways to boost efficiency and effectiveness. • Timely Documentation: Clearly record and communicate claims activity for smooth resolution.

Job DetailsJob Location: Allied Benefit Systems - CHICAGO, IL 60606Position Type: Full TimeSalary Range: $20.00 - $21.00 HourlyJob Category: ClaimsPOSITION SUMMARY: The Appeals Specialist will be responsible for the organization and completion of all claim appeals received in the Appeal Department. ESSENTIAL FUNCTIONS: Reviewing appeal and supporting documentation Reviewing Summary Plan Documents to determine validity of appeal Composing appeal response letters when necessary Communicating with other departments and clients when necessary Documenting the QicLink system and database with appeal status and outcome Emailing claims examiners and other units when necessary Prioritize incoming referrals to complete all tasks timely Performs other related duties as assigned EDUCATION: High School diploma or equivalent required EXPERIENCE AND SKILLS: 3 years or more of comprehensive experience with the billing of or otherwise handling of medical, dental and vision claims required. Applicant should be proficient in the use of the Excel and Word programs Experience with or ability to learn Microsoft Access Be able to communicate effectively both orally and by email Applicant must have the ability to analyze claim situations, take appropriate actions and be great with communication and documentation. Applicant must have a history of excellent quality results and the desire to take on a new challenge if currently employed at Allied. 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 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 & 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.Qualifications

Job DetailsJob Location: Allied Benefit Systems - CHICAGO, IL 60606Position Type: Full TimeSalary Range: $20.00 - $30.00 HourlyJob Category: ClaimsPOSITION SUMMARY: The Appeals Specialist will be responsible for the organization and completion of all claim appeals received in the Appeal Department. ESSENTIAL FUNCTIONS: Reviewing appeal and supporting documentation Reviewing Summary Plan Documents to determine validity of appeal Composing appeal response letters when necessary Communicating with other departments and clients when necessary Documenting the QicLink system and database with appeal status and outcome Emailing claims examiners and other units when necessary Prioritize incoming referrals to complete all tasks timely Performs other related duties as assigned EDUCATION: High School diploma or equivalent required EXPERIENCE AND SKILLS: 3 years or more of comprehensive experience with the billing of or otherwise handling of medical, dental and vision claims required. Applicant should be proficient in the use of the Excel and Word programs Experience with or ability to learn Microsoft Access Be able to communicate effectively both orally and by email Applicant must have the ability to analyze claim situations, take appropriate actions and be great with communication and documentation. Applicant must have a history of excellent quality results and the desire to take on a new challenge if currently employed at Allied. 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 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 & 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.Qualifications