Business Claims Associate

4 days ago


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

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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