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The Claims operations 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 Supervisor is responsible for direct oversight of Claims staff, claims processing workflows, queue management and daily transactional operations. This includes coordinating work-flow, leading efforts in error reduction, supporting team members with claim payment procedures, completing special projects, overseeing team performance, and providing supervision and support of staff. This individual will provide feedback to the Claims Leadership Team regarding identified processing trends, offer process improvement opportunities, raise general areas of concern found in routine review activity and/ or processing, ensure claims processing turnaroung times and quality benchmarks are achieved.


Functional Competencies

• Ensure direct oversight of Claims staff, claims processing workflows, queue management and daily transactional operations and completion and delivery of annual performance reviews.
• Apply knowledge of claims processing workflows, payment processes, and regulatory requirements while developing an understanding of Avēsis contract performance standards and related operational requirements.
• Ensure timely and accurate processing of claims as required by contractual and regulated time frames.
• Manage claims inventory and make recommendations for improving outcomes.
• Train, orient, mentor, and provide performance guidance to staff, including planning and assigning work, setting clear job expectations, and developing goals and objectives for supervised team members.
• Make certain quality and productivity standards are being met or exceeded by the team and individuals.
• Assist management and processors in resolving aged claims or handling of claims adjustment projects.
• Presenting topics and attendance in team meetings related to claims processing reviews and updates for company policies and procedures, audit findings, and other related communications.
• Identify opportunities to develop and implement improvement plans for best operations and outcomes.
• Testing of system modifications to guarantee accurate processing and outcomes.
• Support audit activity including both internal and external audit activity when needed.
• Participate in annual review and maintenance of departmental workflow and Standard operating procedures.
• Communicate timely with internal Avesis stakeholders regarding pending or open deliverables.
• Serve as an escalation point and first-line technical contact for claims processing issues raised by staff.
• Provide general instruction and guidance to staff related to claim adjudication processes and issue resolution.
• Create, maintain, and distribute inventory and production reporting on a weekly, monthly, and quarterly basis.
• Lead and facilitate Claims Team huddles and meetings.
• Apply critical thinking to research root cause analysis of claims issues and processing findings, problem solving at times independently.
• Assist with special projects and perform additional responsibilities as assigned to meet business needs.

Core Competencies:

• Knowledge of CPT, HCPC, Dental and diagnosis coding.
• Knowledge of general claims processing principles.
• Ability to pivot between competing priorities and execute responsibilities within tight deadlines.
• Strong attention to detail and accuracy.
• Strong organizational skills with the ability to manage multiple tasks and meet deadlines.

Behavioral Competencies:

• 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.
• Minimum 3 years of claim processing experience required.
• 2+ years of prior supervisory or leadership experience.
• Knowledge of Medicare, Medicaid, and/or Commercial insurance terminology and high-level clams' payment processes.
• Intermediate in Microsoft Office products, including Excel, Word, Adobe, and other Windows-based tools used to aggregate, analyze, trend and report recommendations for increased operational performance.
• Ability to work flexible hours to accommodate business needs in all time zones.
• 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 10 Mbps upload while hardwired and not on a VPN are sufficient.

Preferred Qualifications:

• Associate’s or Bachelor’s degree in a related field.
• Experience within Dental/Vision insurance claims.

At Avēsis, we strive to design equitable, and competitive compensation programs. Base pay within the range is ultimately determined by a candidate's skills, expertise, or experience. In the United States, we have three geographic pay zones. For this role, our current pay ranges for new hires in each zone are:

Zone A: $50,780.00-$84,640.00
Zone B: $55,320.00-$92,200.00
Zone C: $59,540.00-$99,240.00

FLSA Status: Salary/Exempt

This role may also be eligible for benefits, bonuses, and commission.

Please visit Avesis Pay Zones for more information on which locations are included in each of our geographic pay zones. However, please confirm the zone for your specific location with your recruiter.

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.

How To Stay Safe

Avēsis is aware of fraudulent activity by individuals falsely representing themselves as Avēsis 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.

Avēsis 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 Avēsis recruiters will come from a verified email address ending in @ Avēsiscom.

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. Avēsis is not responsible for any claims, losses, damages, or expenses resulting from unaffiliated individuals of the company or their fraudulent activity.

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!