Join us for an exciting career with the leading provider of supplemental benefits!
Our Promise
Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.
The Claims Processor is responsible for processing dental claims received from providers and health plan members in accordance with policies, procedures, and guidelines as outlined in Avesis contractual agreements. Claims are processed using Avesis systems and on-line reference resources that specify the details and scope of benefits. The processors productive output is guided by performance objectives that specify the volume of claims to be processed on an hourly basis. The Claims Processor must be able to meet accuracy, quality, and productivity standards as determined by Avesis.
This position will focus on skill development as you will be part of a high-performing team. You will be responsible for helping the company to meet our contractional agreements across multiple plans to ensure our members are taken care of. A successful candidate will be able to communicate, retain information and stay on top of multiple changes, and multi-task while meeting the required self-metrics and team metrics.
Essential Job Functions:
- Understand Avesis’ contracts and performance requirements, claims processing workflow and payment process.
- Review claim data for accuracy and process claims in a timely matter according to turn around times set for that plan.
- Thorough knowledge of diagnostic and procedural coding for dental claims.
- Testing, reprocessing, or review of claims in new or existing systems to ensure accurate processing.
- Ability to work all dental plans that Avesis has contracts with
- Working new day/previously paid/ denied claims as needed to correct a claim that was processed inaccurately due to processor or system error.
- Ability to Multitask-processors may be asked to move across multiple Lines of Business to assist as the business needs.
- Skilled use of Avesis systems and applications for claims adjudication and research of provider, member, and utilization management data.
- Apply policies and procedures to confirm that claims meet the criteria for payment as indicated in contractual guidelines.
- Attendance in team meetings related to claims processing reviews and updates for company policies and procedures, audit findings, and other related communications.
- Ability to meet or exceed quality, accuracy, and production standards as determined by Avesis.
- Respond to inquiries from customer service team about claims in a 48hr time period
- Other duties as assigned
Requirements:
- High School Diploma or GED (required), Associates degree in a related field is preferred
- Dental experience required
- Knowledge of Medicare, Medicaid, and Commercial insurance preferred
- HCPCS, CPT, ICD 10 coding
- Strong skills using Microsoft applications (Adobe, Word, Excel, Etc.) and other windows-based tools
- Ability to read, write, and communicate at a professional level
- Ability to manage multiple tasks
- Ability to prioritize work
- Ability to work mandatory overtime as needed
- Effective time management and organizational skills
- Experience within insurance or healthcare organizations preferred
- Excellent listening, communication (verbal and written
FLSA Status: Hourly/Non-Exempt
Salary Range Hourly Rate: $12.51 - $19.59
How to stay safe:
Avesis is aware of fraudulent activity by individuals falsely representing themselves as Avesis recruiters. In some instances, these individuals may even contact applicants with a job offer letter, ask applicants to make purchases (i.e., a laptop or gift cards) from a designated vendor, have applicants fill out W-2 forms, or ask that applicants ship or send packages of goods to the company.
Avesis would never make such requests to applicants at any time throughout our job application process. We also would never ask applicants for personal information, such as passport numbers, bank account numbers, or social security numbers, during process. Our recruitment process takes place by phone and via trusted business communication platform (i.e., Zoom, Webex, Microsoft Teams, etc.). Any emails from Avesis recruiters will come from a verified email address ending in @Avesis.com.
We urge all applicants to exercise caution. If something feels off about your interactions, we encourage you to suspend or cease communications. If you are unsure of the legitimacy of a communication you have received, please reach out to ITsupport@Avesis.com.
To learn more about protecting yourself from fraudulent activity, please refer to this article link (https://consumer.ftc.gov/articles/how-avoid-scam). If you believe you were a victim of fraudulent activity, please contact your local authorities or file a complaint (Link: https://reportfraud.ftc.gov/#/) with the Federal Trade Commission. Avesis is not responsible for any claims, losses, damages, or expenses resulting from unaffiliated individuals of the company or their fraudulent activity.
We Offer
- Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.
- Competitive compensation package.
- Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.
- Life and disability insurance.
- A great 401(k) with company match.
- Tuition assistance, paid parental leave and backup family care.
- Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent.
- Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
- Employee Resource Groups that advocate for inclusion and diversity in all that we do.
- Social responsibility in all aspects of our work. We volunteer within our local communities, create educational alliances with colleges, drive a variety of initiatives in sustainability.
Equal Employment Opportunity
At Avēsis, We See You. We celebrate differences and are building a culture of inclusivity and diversity. We are proud to be an Equal Employment Opportunity employer that considers all qualified applicants and does not discriminate against any person based on ancestry, age, citizenship, color, creed, disability, familial status, gender, gender expression, gender identity, marital status, military or veteran status, national origin, race, religion, sexual orientation, or any other characteristic. At Avēsis, we believe that, to operate at the peak of excellence, our workforce needs to represent a rich mixture of diverse people, all focused on providing a world-class experience for our clients. We focus on recruiting, training and retaining those individuals that share similar goals. Come Dare to be Different at Avēsis, where We See You!
