Customer Success Operations Analyst at Avalon Administrative Services LLC – Tampa, Florida

About the Customer Success Operations Analyst:

The Customer Success Operations Analyst (CSOA) will be a part of the Network Claims Operations Department but will also provide inter-department support. Responsibilities will include claims coding and editing investigation, communicating relevant claims decisioning and impact analysis to providers and health plan clients via ticket submissions or other mechanisms. This role will also include performance of outbound calls and email communications to clients for status updates on claims issues to facilitate issue resolution. The CSOA will be expected to fax documentation weekly to the health plans and meeting departmental quotas, KPIs and quality standards. Additionally, the CSOA collects data from clients and claims to determine trends, provide feedback and work with management to create business process. This individual is expected to work collaboratively with other departments as well as understanding the processes within their own departments to assist clients with questions and triage information within the organization.

This position is eligible for remote work, but quarterly travel to the corporate office in Tampa, Florida may be required.

Customer Success Operations Analyst - Essential Functions and Responsibilities:

• Acts as the Operational Subject Matter experts for client engagement
• Develop and provide customer and provider education as needed.
• Evaluate disputed claims in denial management process for system configuration, claims processing, and/or contractual issues to facilitate Health plan review of claims.
• Track client and provider issues and monitor trends to support their resolution.
• Schedule meetings with clients or providers as required to resolve issues or provide education.
• Effectively and accurately communicates client needs and advocates on their behalf.
• Collects data from clients relating to claims and escalate to management.
• Develop, run, and execute client queries and or internal reports.
• Responds to provider and client ticket requests within established turnaround times.
• Makes regular status updates to tickets.
• Provides excellent customer service to clients.
• Understands Business Needs and Business Process
• Understand Department needs and recommends resources for process improvements.
• Collaborates with other departments to support client needs.
• Assists with special assignments and projects that require extensive and thorough research.
• Performs outbound calls to Health Plans to investigate aging reconsideration submissions and claims payment details.
• Performs other duties as assigned.
• To provide analysis and facilitation of issue resolution for our health plan clients.
• Deliver timely analysis of claims in response to providers.
• Storing and maintenance of multiple electronic documents.

Customer Success Operations Analyst - Qualifications:

• Bachelor’s Degree or minimum of 3 years related work experience in a similar role.
• Minimum 3 years’ experience working in the health insurance industry.
• 3 years medical, billing and coding required.
• Certified professional coder certification preferred.
• Strong Customer service experience
• Some Understanding of health insurance claims and terminology
• Good communication skills
• Basic knowledge of Microsoft Office Suite products
• Exceptional interpersonal skills with demonstrated ability to work independently as well as with a team.
• Strong organizational skills
• Some experience working with Health Savings Accounts
• Willingness to learn new skills and ability to multi-task.
• Demonstrate ability to problem solve and utilize analysis, experience, and judgement to make accurate decisions.

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