Claims Associate

Avalon Administrative Services LLC

89d

About The Position

The Business Claims Associate will be a part of the Claims Operations Department and will report to the Claims Operations Supervisor. Responsibilities of the Claims Associate includes the submittal of weekly Provider Reconsideration faxes to multiple health plans and providing follow ups when appropriate. The Claims Associate will also upload faxed confirmations and health plan determination letters to in process tickets and will be expected to monitor Reconsideration queue to identify discrepancies. This role will also include performance of outbound calls and email communications to clients for status updates on tickets submissions to facilitate issue resolution. The Claims Associate will evaluate provider issues presented on Provider Support tickets and work with the Senior team and management to determine trends and assist in driving resolution. Additionally, this role will include support of Network Operations. This position is eligible for remote work, but quarterly travel will be required to Avalon's corporate office located in Tampa, Florida.

Requirements

• 1-2 years in a business office and fast paced environment
• High School Diploma or GED
• Good customer service and communication skills
• Attentive to details and organized
• Intermediate knowledge of Microsoft Office Suite products
• Excellent interpersonal skills
• Willingness to learn new skills
• Experience with using eFax and performing outbound phone calls to clients
• This position follows a standard 5-day work week, with the option to transition to a 4x10 schedule upon successful completion of a 90-day period

Nice To Haves

• Associate Degree preferred but not required
• Experience working in the health care industry is preferred but not required
• Experience with Provider credentialing is preferred but not required

Responsibilities

• Submit Provider Reconsideration tickets to multiple Health plans
• Evaluate disputed claims in Reconsideration process and share findings with Senior staff to determine scope
• Maintain and update Provider demographic records for network participation
• Uploading Health plan determination letters to appropriate Reconsideration tickets
• Track Provider issues and monitor trends to support their resolution
• Update and respond to provider ticket requests within established turnaround times
• Provide excellent customer service to providers
• Collaborate with other departments to support provider needs
• Perform outbound calls to Health Plans to investigate aging reconsideration submissions and claims payment details
• Maintenance of various logs
• Research and resolve provider inquiries
• Perform other duties as assigned
• Store and maintain multiple electronic documents
• Ability to multi-task

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 101-250 employees