Claims Associate at Avalon Administrative Services LLC in Tampa, Florida

Job Description:

Title: Claims Associate

Category: Full Time


Requsition ID: 1006

Description:

About the Business Claims Associate:

The Business Claims Associate will be a part of the Claims Operations Department and will report to the Claims Operations Supervisor. Responsibilities of the Claims Associate includes the submittal of weekly Provider Reconsideration faxes to multiple health plans and providing follow ups when appropriate. The Claims Associate will also upload faxed confirmations and health plan determination letters to in process tickets and will be expected to monitor Reconsideration queue to identify discrepancies. This role will also include performance of outbound calls and email communications to clients for status updates on tickets submissions to facilitate issue resolution. Additionally, the Claims Associate will evaluate provider issues presented on Provider Support tickets and work with the Senior team and management to determine trends and assist in driving resolution. Additionally, this role will include support of Network Operations. Furthermore, this position will also provide support for Network Operations, which includes the review and research of claims, verification of provider documentation, and the creation of ad-hoc reports

This position is eligible for hybrid-remote work and will be required to report to the corporate office in Tampa, Florida for 1-2 days per week.

Business Claims Associate – Essential Functions and Responsibilities:

• Submit Provider Reconsideration tickets to multiple Health plans
• Evaluate disputed claims in Reconsideration process and share findings with Senior staff to determine scope
• Maintain and update Provider demographic records for network participation.
• Uploading Health plan determination letters to appropriate Reconsideration tickets
• Track Provider issues and monitor trends to support their resolution.
• Update and responds to provider ticket requests within established turnaround times.
• Provides excellent customer service to providers.
• Collaborates with other departments to support provider needs.
• Performs 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.
• Performs other duties as assigned.
• Storing and maintenance of multiple electronic documents.
• Ability to multi-task

Business Claims Associate – Minimum Qualifications:

• 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

Business Claims Associate – Minimum Qualifications:

• Associate degree preferred but not required
• Experience working in the health care industry is preferred but not required
• Experience with Provider credentialing is preferred but not required

Equal employment opportunity, including veterans and individuals with disabilities.

PI266516360

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