Claims Processor -Dental and Vision

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.

As a Claims Processor at Avesis you will help create communities and systems of care that supports everyone having access to quality healthcare and services while being treated with dignity. With over 40 years’ experience managing commercial and government-sponsored benefit programs, we’re one of the leading vision and dental insurance services companies in the nation, with an extensive network of providers. We provide essential vision, dental benefits to small and large businesses, municipalities, government agencies, and major medical providers and ensure members receive necessary dental and vision services to support overall health.

The Claims team at Avesis is responsible for timely and accurately processing all claims. This is the team's continual commitment to ensure provider payments are accurate and member benefits are maximized. We have a proven track record for processing clean claims within 30 calendar days or less, reducing provider abrasion and increasing member satisfaction.

The Claims Processors are responsible for the accurate and timely processing of Dental and Vision claims. This role requires the ability to investigate and complete claims received according to procedural and financial standards while meeting production metrics. The ideal candidate should have a working knowledge of Third Party Administration and claims adjudication, including the interpretation of benefit applications to claims. The ability to multitask and work effectively in a production based environment is essential. These team members must be able to consistently meet accuracy, quality, and productivity standards as determined by Avesis.

Competencies:

Functional:

• Consistently and accurately adjudicate Dental and Vision claims.

• Review, research, and process complex claims.

• Meet production and quality standards.

• Handle recalculation of claims due to incorrect claim payments or receipt of additional information.

• Investigate and resolve claim discrepancies and issues in a timely manner.

• Maintain up-to-date knowledge of industry standards, regulations, and company policies related to claims processing.

• Document claim actions and decisions thoroughly in the claims processing system.

• Collaborate with team members to improve processes and efficiency.

• Participate in training sessions and stay current with changes in procedures and guidelines.

Core:

• Knowledge of CPT, HCPC, Dental and diagnosis coding.

• Knowledge of general claims processing principles.

• Excellent data entry, problem-solving, and analytical skills. Ability to interpret and apply benefits to claims based on a Summary Plan Description.

• Strong attention to detail and accuracy.

• Strong organizational skills with the ability to manage multiple tasks and meet deadlines. Strong communication skills, both verbal and written.

Behavioral:

• Collegiality: building strong relationships on company-wide, approachable, and helpful, ability to mentor and support team growth. 

• Initiative: readiness to lead or take action to achieve goals.

• Communicative: ability to relay issues, concepts, and ideas to others easily orally and in writing.

• Member-focused: going above and beyond to make our members feel seen, valued, and appreciated.

• Detail-oriented and thorough: managing and completing details of assignments without too much oversight.

• Flexible and responsive:  managing new demands, changes, and situations.

• Critical Thinking: effectively troubleshoot complex issues, problem solve and multi-task.

• Integrity & responsibility:  acting with a clear sense of ownership for actions, decisions and to keep information confidential when required.

• Collaborative: ability to represent your own interests while being fair to those representing other or competing ideas in search of a workable solution for all parties.

Minimum Qualifications:

• High School Diploma or GED is required.

• 1-3 years of experience with Medicare, Medicaid, and/or Commercial insurance terminology and high-level clams' payment processes. 

• 1-3 years utilizing basic Excel skills to include sort/filter functions.

• 1-3 years of experience using multiple screens and systems simultaneously.

• Ability to work mandatory overtime as needed outside of your normally scheduled shift is required. This mandatory OT can be worked during any days and times the system is available, as long as it falls within the 7-day work week in which it is assigned.

• Excellent listening, communication (verbal and written)

• As this role is a remote role, you are required to maintain internet service that allows you to complete your essential job duties without issue. Rates of 50 Mbps download and 25 Mbps upload while hardwired and not on a VPN are sufficient.

Preferred Qualifications:

• Associates degree in a related field is preferred

• Experience within Dental/Vision insurance or healthcare organizations preferred 

• Experience with HCPCS, CPT, ICD 10 coding

• Dental and/or Vision Claims Processing experience

FLSA Status: Hourly / Non-Exempt

National Hourly Range: $15.20 - $23.73

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 our 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!

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