Business Claims Associate

4 weeks ago


Tampa, Florida, United States Avalon Administrative Services, LLC dba Avalon Healthcare Solutions Full time
Job Summary

Avalon Administrative Services, LLC dba Avalon Healthcare Solutions is seeking a highly organized and detail-oriented Business Claims Associate to join our Claims Operations Department. As a Business Claims Associate, you will play a critical role in ensuring the timely and accurate processing of provider reconsideration requests.

Key Responsibilities:

  • Submit weekly provider reconsideration faxes to multiple health plans and follow up as necessary
  • Upload faxed confirmations and health plan determination letters to in-process tickets
  • Monitor the reconsideration queue to identify discrepancies and perform outbound calls to health plans to investigate aging reconsideration submissions and claims payment details
  • Evaluate provider issues presented on provider support tickets and work with senior staff to determine trends and assist in driving resolution
  • Support network operations and perform other duties as assigned

Requirements:

  • Associate's degree preferred, but not required
  • Experience working in the healthcare industry is preferred, but not required
  • Good customer service and communication skills
  • Attention to detail and organizational skills
  • Intermediate knowledge of Microsoft Office Suite products
  • Excellent interpersonal skills
  • Willingness to learn new skills

About Avalon Healthcare Solutions:

Avalon Healthcare Solutions is a high-growth company that is committed to improving clinical outcomes and healthcare affordability for the people we serve. We are proud to be an equal opportunity employer and are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or veteran status.



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