Business Claims Associate
4 days ago
Avalon Healthcare Solutions is a leading provider of lab insights and benefit management solutions. As a Business Claims Associate, you will play a critical role in ensuring the accuracy and efficiency of our claims processing operations.
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
- Maintenance of various logs
- Excellent written and verbal communication skills
- Research and resolve provider inquiries
Requirements:
- Associate's degree preferred, but not required
- Experience working in the healthcare industry is preferred, but not required
- Experience with Provider credentialing is preferred, but not required
- 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
Avalon Healthcare Solutions is an equal opportunity employer and is committed to providing a work environment that is free from discrimination and harassment. We are proud to be a part of the Avalon Administrative Services, LLC dba Avalon Healthcare Solutions team and look forward to hearing from you.
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Business Claims Associate
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Tampa, Florida, United States Avalon Administrative Services, LLC dba Avalon Healthcare Solutions Full timeAbout Avalon Healthcare SolutionsAvalon Healthcare Solutions is a leading provider of healthcare services, dedicated to delivering high-quality care to patients across the country. Our team of experienced professionals is committed to excellence in every aspect of our work, from claims processing to patient care.Job SummaryWe are seeking a highly skilled...
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Business Claims Associate
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