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Dental Claims Processor at Avesis in Phoenix, Arizona

Posted in General Business 30+ days ago.

Type: Full-Time

Job Description:

About the Organization Avesis has been providing essential ancillary benefit solutions since 1978. Since its inception Avesis has developed, administered and refined its offerings to provide clients with best-in-class product choices and services. Today, our programs cover more than 8.5 million members throughout the country. We strive for excellence in all that we do and our benchmark performance in terms of member satisfaction and client retention underscores this singular focus.

The continued upward spiral in health care costs has challenged sponsors, providers and payers of health benefits to deliver high quality care in the most cost-effective manner possible. The Avesis benefits menu has been created to meet that challenge by making available quality essential ancillary benefit services at the lowest possible price while never sacrificing the highest quality of service. Providing outstanding customer service is a top priority, and our core values of accountability, empowerment, excellence, and integrity help us achieve high member and client satisfaction.

As of January 2016 Avesis is a wholly-owned, independent subsidiary of The Guardian Life Insurance Company, a distinction that brings even more capabilities to Avesis. The Guardian is a Fortune 250 mutual insurance company that has put its policyholders and clients above all else for more than 150 years, and it has earned them not only a great reputation but awards and accolades from such authorities as J.D. Power. Adhering to high standards, doing the right thing, and making people count are the founding principles that has kept Guardian financially sound and made them one of the largest insurance companies in the country.

In January 2017, Premier Access joined the Avesis family. Premier Access has focused on direct state contracts for Medicaid and Chip, specifically in California and Utah. They were one of the original participants in the Chip and Medicaid programs. Description Position Overview
This position is located in the Claims Department of Avesis' operations center in Phoenix, Arizona. The Claims Processor is responsible for processing vision, dental and hearing program claims received from providers and health plan members for which Avesis is contracted to support. Claims are processed using Avesis systems and on-line reference resources that specify the details and scope of benefits for members and specifics relating to reimbursement details for contracted and out of network providers. The Claims Processor's productive output is guided by performance objectives for the position that specify the volume of claims to be processed on an hourly basis and required accuracy and quality performance standards.

Essential Job Functions

  • Understanding Avesis' health plan contracts and performance requirements, claims processing work flow and payment process, and a thorough knowledge of diagnosis and procedural coding for vision, dental, and hearing program claims
  • Skilled use of Avesis systems and applications for provider network and member data, utilization management, claims adjudication, and customer service
  • Processing of vision, dental and hearing program claims from health plan members, contracted and out of network providers using related Avesis systems and applications
  • Maintaining standardized productivity, accuracy and quality performance standards for claims processed
  • Attend weekly Team Lead meetings relating to claims processing reviews, updates on company and departmental policies and procedures, reviews of claims audit findings, and other related communications
  • Other duties as assigned
Position Requirements Requirements

  • Prior claims processing experience preferred
  • Associate's degree in a related field is preferred; High School diploma required
  • Knowledge of Medicare, commercial and Medicaid insurance and CPT and ICD-9/10 codes
  • Excellent written and verbal communication skills
  • Strong skills in using Microsoft Office applications and other windows-based applications

Category Claims Full-Time/Part-Time Full-Time Exempt/Non-Exempt Non-Exempt EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law. This position is currently accepting applications.