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