Claims Associate - Military veterans preferred

About Avalon Healthcare Solutions:

Avalon Healthcare Solutions is the nation’s leader in diagnostic intelligence, uniquely focused on transforming the role of diagnostic testing across the healthcare ecosystem. Our proprietary Diagnostic Insights Platform delivers evidence-based policies, curated lab networks, and real-time analytics that simplify complex diagnostics, accelerate innovation adoption, and optimize diagnostic investments.

Supporting over 30 health plans and 44 million members nationwide, Avalon partners with payers and providers to ensure diagnostic testing is performed appropriately, efficiently, and at the right time. Our flexible solutions span routine and genetic testing management, automated adherence, and end-to-end diagnostics support—driving measurable value, reduced waste, and improved clinical outcomes.

With unmatched scientific rigor, deep clinical expertise, and a performance-based model, Avalon is redefining how diagnostics power personalized care and healthcare value.
 Learn more at www.avalonhcs.com.

You will be part of a team that shapes a new market and business. Most importantly, you will help Avalon to achieve its mission and improve clinical outcomes and health care affordability for the people we serve.

For more information about Avalon, please visit www.avalonhcs.com.

Avalon Healthcare Solutions, and its affiliates, is an equal opportunity employer.  This position description is subject to change at any time. As determined by the company based upon business needs, an employee in this position may be required to perform duties and take responsibility for work other than as described in this document.

About the Claims Associate Position:

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. 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.

This position is eligible for remote work, but quarterly travel will be required to Avalon's corporate office located in Tampa, Florida.

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

Claims Associate – Minimum Qualifications:

• 1-2 years in a business office and fast paced environment.
• High School Diploma or GED
• 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
• This position follows a standard 5-day work week, with the option to transition to a 4x10 schedule upon successful completion of a 90-day period

Claims Associate – Preferred 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