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Business Claims Associate
2 months ago
Avalon Administrative Services, LLC dba Avalon Healthcare Solutions is a leading provider of innovative healthcare solutions, dedicated to improving clinical outcomes and healthcare affordability for millions of lives across the country.
Job SummaryWe are seeking a highly skilled 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 resolution of provider disputes, working closely with our Senior team and management to identify trends and drive resolution.
Key Responsibilities- Submit Provider Reconsideration tickets to multiple health plans and follow up as necessary to ensure timely resolution.
- Evaluate disputed claims in the Reconsideration process and share findings with Senior staff to determine scope and drive resolution.
- Upload health plan determination letters to appropriate Reconsideration tickets and track provider issues to support resolution.
- Provide excellent customer service to providers, responding to their inquiries and resolving issues in a timely and professional manner.
- Collaborate with other departments to support provider needs and drive business growth.
- Perform outbound calls to health plans to investigate aging reconsideration submissions and claims payment details.
- Maintain accurate and up-to-date records and logs, ensuring compliance with regulatory requirements.
- Perform other duties as assigned, including weekly visits to the office to open mail, scan documents, and distribute paper checks.
- Associate Degree preferred but not required.
- Experience working in the healthcare industry is preferred but not required.
- Excellent customer service and communication skills, with the ability to work effectively with diverse stakeholders.
- Attention to detail and organizational skills, with the ability to prioritize tasks and manage multiple projects simultaneously.
- Intermediate knowledge of Microsoft Office Suite products, including Word, Excel, and Outlook.
- Excellent interpersonal skills, with the ability to build strong relationships with colleagues and external partners.
- Willingness to learn new skills and adapt to changing business needs.
Avalon Administrative Services, LLC dba Avalon Healthcare Solutions offers a dynamic and supportive work environment, with opportunities for professional growth and development. We are committed to equal employment opportunity and welcome applications from diverse candidates.
