Claims Coordinator in at AVASO Federal Solutions Inc

Position Summary

The Claims Coordinator supports payor-side claims operations by monitoring related claim and medical review inquiries, retrieving documentation requests, routing information to the appropriate internal departments and tracking inquiry activity through resolution. This role helps ensure that medical review requests, claim inquiries, and payor portal updates are handled accurately, timely, and in alignment with internal procedures.

Payor Portal Role

The coordinator uses the payor/provider portal, which may be referred to as the portal depending on the organization’s system setup, to review incoming inquiries, retrieve medical record requests, update inquiry statuses, and document responses based on internal review outcomes. This position does not typically adjudicate or pay claims directly; instead, it provides intake, coordination, routing, tracking and administrative

claims support.

Essential Duties and Responsibilities

• Monitor the portal daily for new claim-related, medical review, or documentation inquiries.

• Retrieve and organize medical record requests or supporting documentation from the portal.

• Review incoming inquiries to determine the correct internal department for handling.

• Route inquiries and documentation to claims operations, medical review, or other internal teams for follow-up.

• Review QicLink or applicable internal systems to identify inquiry responses, rulings, or claim-related updates.

• Update the portal with appropriate status information or responses based on internal review outcomes.

• Track inquiry progress using Microsoft Outlook, Excel, and internal data systems.

• Identify and escalate time-sensitive cases in partnership with the medical review team.

• Communicate with internal departments to obtain needed information, documentation, or clarification.• Maintain accurate records of assigned inquiries, actions taken, and pending follow-up items.

• Perform other duties as assigned.

Minimum Qualifications

• High school diploma or equivalent required.

• At least 1 year of administrative, claims support, healthcare, insurance, or third-party administration experience preferred.

• Ability to work accurately with claim-related documentation, medical record requests and inquiry tracking tools.

• Proficiency with Microsoft Outlook, Word, and Excel.

• Ability to learn internal claims systems, payor portals, and tracking processes.

• Strong attention to detail, organization, and follow-through.

• Excellent written and verbal communication skills.

• Ability to work independently in a remote environment and manage multiple priorities.

Preferred Qualifications

• Experience working with the payor/provider portals.

• Experience with QicLink or similar claims administration systems.

• Knowledge of medical terminology.

• Prior experience supporting medical review, utilization review, claims inquiry intake, or provider inquiry workflows.

• Experience handling time-sensitive documentation requests or claim-related follow-up.