Business Claims Associate

2 days ago

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

Avalon Healthcare Solutions is a leading provider of lab insights and benefit management solutions. Our company is headquartered in Tampa, Florida, and we are committed to delivering high-quality services to our clients.

Job Summary

We are seeking a highly skilled 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
  • Maintain various logs
Requirements
  • Associate 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
About the Company

Avalon Healthcare Solutions is a high-growth company where every associate has an opportunity to make a difference. We 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.

We are proud to be an equal opportunity employer and are committed to creating a diverse and inclusive work environment.

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