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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. Our cutting-edge Lab Insights Platform captures, digitizes, and analyzes lab results in real-time, providing actionable insights for earlier disease detection, ensuring appropriate treatment protocols, and driving down overall cost.
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, maintaining excellent customer service, and collaborating with cross-functional teams to drive business growth.
Key Responsibilities- Submit Provider Reconsideration tickets to multiple health plans, ensuring timely and accurate resolution of disputes.
- Evaluate disputed claims in the Reconsideration process, sharing findings with senior staff to determine scope and drive resolution.
- Upload health plan determination letters to appropriate Reconsideration tickets, maintaining accurate records and ensuring seamless communication.
- Track provider issues and monitor trends to support resolution, identifying areas for process improvement.
- Update and respond to provider ticket requests within established turnaround times, providing exceptional customer service.
- Collaborate with other departments to support provider needs, fostering strong relationships and driving business growth.
- Perform outbound calls to health plans to investigate aging reconsideration submissions and claims payment details, ensuring accurate and timely resolution.
- Maintain various logs, ensuring accurate and up-to-date records.
- Excellent written and verbal communication skills, with the ability to research and resolve provider inquiries.
- Perform other duties as assigned, supporting the Claims Operations Department in achieving business objectives.
- 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, with the ability to multitask and prioritize tasks.
- Attentive to details and organized, with intermediate knowledge of Microsoft Office Suite products.
- Excellent interpersonal skills, with the ability to work effectively in a team environment.
- Willingness to learn new skills and adapt to changing business needs.
- Experience with using eFax and performing outbound phone calls to clients is a plus.
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 provide a comprehensive benefits package, including health insurance, retirement plans, and paid time off.
