Business Claims Associate

3 days ago

Tampa FL USA, United States Avalon Administrative Services, LLC dba Avalon Healthcare Soluti Full time
About Avalon Healthcare Solutions

Avalon Healthcare Solutions is a leading provider of lab insights and benefits management solutions. Our team is dedicated to helping healthcare insurers proactively inform appropriate care, reduce costs, and improve clinical outcomes.

Job Summary

We are seeking a highly organized and detail-oriented Business Claims Associate to join our Claims Operations Department. The successful candidate will be responsible for submitting weekly Provider Reconsideration faxes to multiple health plans, providing follow-ups when necessary, and uploading faxed confirmations and health plan determination letters to in-process tickets.

Key Responsibilities
  • Submit Provider Reconsideration tickets to multiple health plans
  • Evaluate disputed claims in the Reconsideration process and share findings with senior staff to determine scope
  • Upload 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
Requirements
  • Associate degree preferred but not required
  • Experience working in the healthcare industry is preferred but not required
  • Good customer service and communication skills
  • Attentive to details and organized
  • Intermediate knowledge of Microsoft Office Suite products

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