Avesis

Role Description As a Utilization Management Clinical Dental Processor, you will leverage your professional judgment to evaluate service requests and determine their appropriateness, assessing the necessity of treatments prior to provision. You will apply national clinical criteria and maintain up-to-date knowledge of relevant laws, regulations, and organizational policies, utilizing clinical judgment in your evaluations. To meet our client standards, you will be required to complete 13 to 18 cases per hour, ensuring our contractual obligations are fulfilled. Additionally, you will complete clinical scripts, review patient histories, and import supporting documentation into our internal system. Work hours will be determined by your manager and may vary based on location, department needs, and workflow. Mandatory overtime may be required during peak seasons. - Conducts reviews of prior authorizations by providers, determining cases of recommended treatment in accordance with Avesis UM procedural guidelines or refers the case to Clinical Director or consultant for professional review of clinical denials. - Ensures that the right systems, processes, and measurements are in place to assist with accurate clinical determinations. - Understands and upholds Avesis’ policies and obligations relative to the UM reviews required by each client contract. - Documents approval decisions for treatment in accordance with prescribed UM department procedural guidance, and forwards applicable files to the client health plan as required by each contract. - Provides recommendations on department policies, objectives, and initiatives. Evaluates and suggests changes as necessary to optimize processes and efficiencies. - Maintains a daily level of productivity in accordance with departmental requirements for production and quality standards. - Maintains effective intradepartmental communications through sharing of plans, general company news and other information through informal interactions; actively participates in routine departmental meetings. - Other duties as assigned. Qualifications - High School Diploma/GED - Dental Assistant or Dental Hygienist required. - Dental Assistant certificate or 2 years of chair side assisting. - 1-2 years of experience reviewing dental x-rays, models, photos, and patient charts required. - Proficiency with Microsoft Office and other Windows-based applications. - Strong reading, writing, and professional communication skills. - Ability to manage multiple tasks and prioritize work. - Adaptability to handle multiple and changing priorities. - Effective time management and organizational skills. - Access to reliable internet connection (25 MBPS upload/10 MBPS download speed) and an appropriate workspace are essential for success in this remote role. Requirements - X-Ray certification is highly preferred. - Knowledge of Medicare, Medicaid, or commercial insurance. - Experience with HCPCS, CPT, CDT, and ICD-10 coding. Benefits - 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.

Role Description The Account Specialist is responsible for supporting assigned small group dental and vision accounts through proactive client service, renewal coordination, issue resolution, and ongoing account management activities. This role manages day-to-day communication with brokers and clients, coordinates with internal departments, supports retention initiatives, and assists with renewal and upsell opportunities for groups under 100 enrolled members. Communication / Client Support - Communicate internally and externally to support assigned accounts and ensure timely resolution of client needs - Respond to phone calls, emails, and client inquiries - Participate in client presentations and meetings (in person and via Teams) - Monitor assigned inboxes and requests through completion - Serve as a primary point of contact for assigned accounts Inquiry Resolution - Support eligibility, claims, billing, and general account inquiries - Process requests for information and commission statement requests - Coordinate Broker of Record change requests - Partner with internal departments to resolve client issues and escalations Billing & Enrollment Support - Provide invoice copies and assist with billing-related questions - Support enrollment inquiries and enrollment clarification requests - Coordinate with Eligibility and other internal departments to ensure accuracy of member information - Assist with open enrollment materials and scheduling requests Renewal & Retention Management - Manage assigned renewal block for groups under 100 enrolled members - Review upcoming renewals and proactively engage brokers and clients prior to contract expiration - Conduct scheduled renewal outreach and account check-ins throughout the policy lifecycle - Coordinate renewal discussions, benefit reviews, and plan option presentations with internal departments and sales partners as needed - Identify retention and upsell opportunities based on client utilization, benefit usage, and market conditions - Assist with implementation of renewal changes and approved plan modifications - Maintain ongoing broker and client communication throughout the renewal process - Monitor market trends and competitive conditions impacting renewal strategy - Escalate renewal risks, client concerns, and retention challenges appropriately - Maintain accurate renewal tracking, documentation, and follow-up activities Administrative / Operational Support - Maintain accurate records and update client profiles - Support account reviews, implementation activities, and internal projects - Assist with custom reporting and market turnaround requests - Support product, benefit, and pricing communications - Handle escalated issues within assigned block of business Qualifications - 2+ years of Account Management, Customer Service, or Sales or similar job function in an insurance industry related environment - Experience in Managed Care and/or healthcare account management preferred - Health and Life producer license required - Regional travel required up to 30% throughout the year - Enhanced travel demands in Q4 are essential within the assigned territory for success in this role - Required internet service of 50 Mbps download and 10 Mbps upload while hardwired and not on a VPN Preferred Qualifications - Capability to educate the client and manage expectations accordingly - Exhibit excellent relationship building skillset and mindset - Possess a forward-thinking mindset; regularly assess, clarify, and validate customer needs - Demonstrate exceptional written and oral communication - Assume additional responsibilities, including special projects as needed - The ability to work together as a team within your region and as a part of Account Management as a whole Benefits - 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

Role Description The Appeals and Grievances Coordinator is the primary point of contact for members, providers, and clients throughout the appeals and grievances process. Although this role will report to the Supervisor, Appeals and Grievances, this individual will receive day-to-day performance support and case guidance from the A&G Team Lead. You will provide timely, accurate, and compliant resolution of dental and vision A&G cases within a regulated managed care environment. The coordinator collaborates with Claims, Provider Relations, Customer Service, and Clinical teams, and is expected to contribute to team onboarding and knowledge sharing as their experience grows. - Responsible for the completion of appeals and grievances from all states - Perform reviews of member and provider appeals and grievances for dental and vision waiver services - Analyze medical records, supporting documentation, and applicable guidelines to make informed decisions - Document rationale clearly and accurately in alignment with organizational and regulatory standards - Work closely with clinical teams as well as other internal operational areas to resolve complex cases - Communicate outcomes effectively to members and providers - Review and complete all provider appeals and grievances within required timeframes - Review and complete member appeals and grievances within required timeframes - Apply Avesis policy, plan documents and/or state guidelines when processing appeals or grievances - Issue administrative denials appropriately - Refer denials based on medical necessity to appropriate clinical staff - Collaborate with appropriate stakeholders to prepare all requests for Independent External Review when required - Participate in training programs to maintain functional expertise - Perform any other job duties as requested Qualifications - High school diploma or equivalent - 1+ years of exposure with medical, dental or vision terminology and/or coding (ICD-10, CDT, CPT) - 1+ years of experience with case management platforms or healthcare administrative systems - Working knowledge of medical, dental, or vision terminology and coding (ICD-10, CDT, CPT) relevant to the line of business - Proficiency in Microsoft Office Suite and experience with case management platforms or healthcare administrative systems - Ability to draft formal correspondence - Demonstrated understanding of HIPAA and the ability to handle protected health information in a compliant manner - Proven ability to manage a high-volume caseload, prioritize competing deadlines, and meet strict regulatory turnaround time requirements - Strong attention to detail, critical thinking, and sound judgment with the ability to work both independently and collaboratively across departments - Flexible to work alternating Saturday during holiday shifts as required - Maintain internet service that allows you to complete your essential job duties without issue (50 Mbps download and 10 Mbps upload while hardwired and not on a VPN) Requirements - 1+ years of experience drafting adverse determination letters, supporting audit readiness, or working in managed care A&G case management platforms - Familiarity with applicable federal and state regulations governing appeals and grievances, including 42 CFR Parts 422 and 438 and NCQA standards - Registered Dental Hygienist or Dental Assistant credential Benefits - 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

Role Description As a Utilization Management Clinical Dental Processor, you will leverage your professional judgment to evaluate service requests and determine their appropriateness, assessing the necessity of treatments prior to provision. You will apply national clinical criteria and maintain up-to-date knowledge of relevant laws, regulations, and organizational policies, utilizing clinical judgment in your evaluations. To meet our client standards, you will be required to complete 13 to 18 cases per hour, ensuring our contractual obligations are fulfilled. Additionally, you will complete clinical scripts, review patient histories, and import supporting documentation into our internal system. Work hours will be determined by your manager and may vary based on location, department needs, and workflow. Mandatory overtime may be required during peak seasons. - Conducts reviews of prior authorizations by providers. - Determines cases of recommended treatment in accordance with Avesis UM procedural guidelines or refers the case to Clinical Director or consultant for professional review of clinical denials. - Ensures that the right systems, processes, and measurements are in place to assist with accurate clinical determinations. - Understands and upholds Avesis’ policies and obligations relative to the UM reviews required by each client contract. - Documents approval decisions for treatment in accordance with prescribed UM department procedural guidance. - Provides recommendations on department policies, objectives, and initiatives. - Maintains a daily level of productivity in accordance with departmental requirements for production and quality standards. - Maintains effective intradepartmental communications through sharing of plans and actively participates in routine departmental meetings. - Other duties as assigned. Qualifications - High School Diploma/GED. - Dental Assistant or Dental Hygienist required. - Dental Assistant certificate or 2 years of chair side assisting. - 1-2 years of experience reviewing dental x-rays, models, photos, and patient charts required. - Proficiency with Microsoft Office and other Windows-based applications. - Strong reading, writing, and professional communication skills. - Ability to manage multiple tasks and prioritize work. - Adaptability to handle multiple and changing priorities. - Effective time management and organizational skills. - Access to reliable internet connection (25 MBPS upload/10 MBPS download speed) and an appropriate workspace are essential for success in this remote role. Requirements - X-Ray certification is highly preferred. - Knowledge of Medicare, Medicaid, or commercial insurance. - Experience with HCPCS, CPT, CDT, and ICD-10 coding. Benefits - 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.

Role Description The Provider Relations Resolution Specialist plays a critical role in ensuring the effective resolution of complex dental and vision claims while supporting provider credentialing efforts through proactive outreach and document collection. This position requires strong analytical and problem-solving skills, attention to detail, and the ability to communicate clearly and professionally with providers and internal stakeholders. The ideal candidate brings experience in dental or vision claims, a collaborative and team-oriented mindset, and a passion for enhancing the provider experience within a growing and innovative organization. Claims Resolution & Research (Primary 70%) - Investigate and resolve complex dental and vision claims by working with payers, providers, and internal teams. - Conduct monthly root cause analysis on recurring claim issues and recommend process improvements. - Accountable for research and resolution of claims check trace requests for both in and out of network providers, accountable for the end-to-end process while collaborating with internal stakeholders. - Partner with multiple cross-functional departments and vendors to resolve claims issues timely and efficiently. - Maintain accurate documentation of claim activity and resolution steps in internal systems. - Demonstrates ownership of individual responsibilities while actively contributing to the overall success of the Provider Relations team. - Supports achievement of departmental operational, quality, and performance KPIs through consistent execution, collaboration, and accountability. - Responds to inquiries within 3 business days, provides education, and may research, analyze, and recommend resolution updates to assist with provider confusion or disputes. - Ability to prioritize and organize a diverse workload required. Credentialing Document Outreach (Secondary 30%) - Assist in the collection of and verification of credentialing documentation from providers and facilities assigned to the Provider Relations Department. - Regularly conducting outreach via phone and email to obtain missing or updated documents. - Track outstanding credentialing items and follow up weekly to ensure timely submission. - Support credentialing compliance by maintaining accurate and up-to-date provider records. Qualifications - 2+ years of experience in dental or vision claims resolution, medical billing, or provider credentialing support. - Comprehension of Dental or Vision Terminology. - High School Diploma or equivalent. - 2+ years of experience in document management, technical writing, provider relations, or a similar role. - 1+ years of experience with Microsoft Office applications, including Word, PowerPoint, and Excel including data analysis and spreadsheet management. - Familiarity with workflow or project management platforms, such as Smartsheet or similar systems. - Strong ability to learn and use additional software programs and systems for data analysis and reporting. - Familiarity with credentialing platforms (e.g., CAQH) and payer portals (e.g., Availity). Requirements - Knowledge of health plan operations preferred. - Knowledge of provider/health plan contracts/agreements highly desired. - Ability to accurately document interactions, including calls, emails, virtual visits, in accordance with departmental standards. - Excellent written and verbal communication skills with strong attention to detail. - Ability to manage multiple projects simultaneously and meet deadlines. Benefits - 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.

Role Description In this role, you’ll be the gatekeeper for ensuring our healthcare partners meet regulatory requirements and industry best practices, directly impacting the quality of care delivered to patients. You’ll work closely with cross-functional teams to ensure provider data is accurate, up-to-date, and compliant. Your work helps shape a trusted network of healthcare providers, ensuring patients receive care from credentialed and qualified professionals. - Facilitate provider onboarding efforts including, but not limited to importing data from CVO into applicable systems, ensuring required documentation is complete and accurate, and ensuring all submitted documentation aligns with industry and organizational standards. - Perform timely follow-up with providers on pending applications/information. - Perform primary source verifications according to the departmental policies and NCQA standards when not completed by CVO. - Build and accurately maintain provider information in various systems. - Respond to inquiries regarding the status of provider’s application. - Utilize organizational templates to communicate with providers about the status of their application with the organization. - Provide support to Credentialing Specialist I on functional responsibilities. Qualifications - Working knowledge of NCQA standards and payer credentialing standards. - Knowledge of vision, dental or hearing industry. - Strong computer, data entry and clerical skills. Requirements - Associate degree or equivalent combination of education and experience. - 3 years credentialing experience, preferably in a managed care setting. - 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. Benefits - 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.

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. The UI and Middleware Integrations Developer is responsible for building and maintaining user‑facing application components and the middleware services that connect them to backend systems. This role ensures that front‑end interfaces, middleware logic, and system integrations work seamlessly to deliver reliable, scalable, and efficient workflows. The developer will collaborate closely with Integrations & Data, Cadence Development, and Production Support to ensure alignment across end‑to‑end systems. Functional: - 10+ years of software development experience - Deep knowledge of API development, SQL, .NET, React, or similar enterprise platforms. - Understanding system integrations, data flows, and interdepartmental technical dependencies. - Excellent communication, prioritization, and conflict‑resolution skills. - Strong problem‑solving mindset with a focus on long‑term system quality and scalability. Core: - Build and enhance front‑end interfaces that are responsive, accessible, and user‑friendly. - Develop middleware services that connect UI applications with backend systems. - Implement integration logic, validation rules, and data transformations. - Ensure smooth data flow across UI, middleware, APIs, and downstream systems. - Troubleshoot end‑to‑end issues across frontend, middleware, and backend layers. - Maintain documentation for UI components, middleware workflows, and integration patterns. Behavioral: - Collegiality: building strong relationships in 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 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 and decisions. - Collaborative: The 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: - 10+ years' Experience with frontend development using a modern framework (React, Angular, or equivalent). - 10+ years’ Experience developing middleware or server-side components using .NET, Node.js, C#, or similar technologies. - Understanding RESTful APIs, integration patterns, and common data formats (JSON, XML). - Advanced SQL skills and knowledge of data flow concepts. - Ability to troubleshoot issues across UI, middleware, and backend layers. - Experience using Git or similar version control tools. - Strong communication and documentation skills. Preferred Qualifications: - Experience building integrations in healthcare or similarly complex, data‑driven environments. - Familiarity with enterprise middleware platforms, integration frameworks, or message queues (e.g., Azure Integration Services, Kafka, RabbitMQ). - Experience with backend APIs or microservices architecture. - Knowledge of DevOps pipelines, CI/CD, and automated testing frameworks. - Understanding of security best practices related to UI, middleware, and API development. - Ability to contribute to architectural discussions and recommend improvements to system design. 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! 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: $67,490.00-$112,490.00 Zone B: $73,550.00-$122,580.00 Zone C: $79,190.00-$131,990.00 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!

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. At Avesis, The Provider Relations Representative I plays a pivotal role within Avesis, acting as the essential liaison between the company and its network of participating vision care providers. As a member of the Provider Relations Department, the Provider Relations Representative is responsible for building and maintaining strong, positive relationships with providers to ensure seamless collaboration and high-quality service delivery. As the face of Avesis to the provider community, the PR1 ensures that both Avesis and its network of providers operate in sync to deliver exceptional vision care to members. This is a fantastic opportunity to make a meaningful impact, work with diverse healthcare professionals, and contribute to the growth and success of a thriving organization. If you're passionate about relationship-building, problem-solving, and driving excellence in healthcare, this role is for you. In this dynamic role, you will be responsible for delivering best-in-class provider education and training, ensuring providers are well-informed on processes, policies, and new initiatives. You'll also be a problem-solver, working to resolve provider issues, researching and addressing challenges, and leading key projects that enhance provider engagement and satisfaction. ***Candidates must reside in the state of Mississippi, per contractual requirements. Functional Competencies: - Provider Relations encompasses several diverse provider administrative duties to improve the Avesis provider experience including direct provider engagement and training with the goal of resolution of issues. - Conducts provider outreach remotely via phone/email/video by providing training, orientation, and coaching for performance improvement within provider practices. Provider guidance through education to enable Avesis network providers to become more self-sufficient in confirming eligibility, claims submission and payment by use of available tools. - Conduct monthly and/or quarterly meetings with provider groups documenting discussions, issues, attendees, action items, researching claims or prior authorization issues on site and routing to the appropriate party for resolution. - Consistently document all provider interactions, including calls, emails, virtual visits, in accordance with departmental standards. Ensures that notes are clear, timely, and accurately reflect the nature of communication to support ongoing relationship management, issue resolution, and continuity of service across teams. - Maintains thorough and timely records to ensure accountability, transparency, and effective information sharing across teams. - Owns and manages relationship and performance of assigned provider groups. Serves as the primary point of contact for assigned providers. - Complete provider orientation via phone, email, or virtually for all applicable product lines to train, resolve issues, and educate staff/providers. - Work in conjunction with Provider Relations Representative II to ensure that provider concerns are addressed (as applicable) - Work closely and coordinates with Avesis Claims, Customer Service, Utilization Management, Clinical Management, Credentialing, Recruitment, Account Management, and other staff to develop operational solutions for various provider network projects. - Knowledge of the provider credentialing and contracting process - Educate providers regarding state program, group policies, and/or health plan policies and procedures and state/federal regulation for compliance requirements. - Investigate and respond to all provider related issues and initiate changes of provider demographic related database information. - Knowledge of and intermediate ability to use various computer programs such as Microsoft Office including spreadsheets, databases, word processing and presentation software and programs/systems utilized in data analysis Core Competencies: - Knowledge of dental health plan operations preferred. - Knowledge of dental provider/health plan contracts/agreements highly desired. - Microsoft applications and other windows-based applications to include an intermediate level in Microsoft Excel and databases. Knowledge of and intermediate ability to use various computer programs such as Microsoft Office including spreadsheets, databases, word processing and presentation software and programs/systems utilized in data analysis. 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: - Must reside in the state of Mississippi - High School diploma or equivalent (Prefer associate degree or higher); experience may substitute for education. - Comprehension of Medical/Dental Terminology. - Previous Dental office administration experience. - The ability to travel 10-20% to attend trade shows required. Travel times may vary and can range from short overnight trips to extended stays. - 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 25 Mbps upload while hardwired and not on a VPN are sufficient. Preferred Qualifications: - Previous Provider Relations experience - Bachelor's degree - Certified Dental Assisting National Board (DANB) certified or Certified dental assistance (CDA). 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! 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: $20.13-$33.54 Zone B: $21.93-$36.54 Zone C: $23.61-$39.35 FLSA Status: Hourly/Non-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!

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 Utilization Management Clinical Dental Processor, you will leverage your dental clinical expertise to review dental x-rays and documentation, assessing medical necessity for prior authorizations. You will perform initial reviews of medical necessity cases, ensuring they comply with member eligibility and the covered services outlined in each client contract. The UM (Utilization Management) Department supports our clients and company through utilizing clinical criteria to approve or deny a service based on the authorization. The UM Clinical Dental Processor plays a crucial role in ensuring that healthcare services provided to members are appropriate, efficient, and effective. They achieve this by utilizing clinical criteria and evidence-based guidelines to evaluate the necessity and appropriateness of treatments As a Utilization Management Clinical Dental Processor, you will leverage your professional judgment to evaluate service requests and determine their appropriateness, assessing the necessity of treatments prior to provision. You will apply national clinical criteria and maintain up-to-date knowledge of relevant laws, regulations, and organizational policies, utilizing clinical judgment in your evaluations. To meet our client standards, you will be required to complete 13 to 18 cases per hour, ensuring our contractual obligations are fulfilled. Additionally, you will complete clinical scripts, review patient histories, and import supporting documentation into our internal system. Work hours will be determined by your manager and may vary based on location, department needs, and workflow. Mandatory overtime may be required during peak seasons. Functional Competencies: - Conducts reviews of prior authorizations by providers -- determining cases of recommended treatment in accordance with Avesis UM procedural guidelines or refers the case to Clinical Director or consultant for professional review of clinical denials. - Ensures that the right systems, processes, and measurements are in place to assist with accurate clinical determinations are rendered - Understands and upholds Avesis’ policies and obligations relative to the UM reviews required by each client contract. - Documents approval decisions for treatment in accordance with prescribed UM department procedural guidance, and forwards applicable files to the client health plan as required by each contract. - Provide recommendations on department policies, objectives, and initiatives. Evaluate and suggest changes as necessary to optimize processes and efficiencies. Works in partnership with Avēsis personnel to improve system efficiency and collaborate on complex barriers that arise. - Maintains a daily level of productivity in accordance with departmental requirements for production and quality standards. - Maintains effective intradepartmental communications through sharing of plans, general company news and other information through informal interactions; and actively participates in routine departmental meetings. - Other Duties as assigned. Core Competencies: - Maintain strict confidentiality of information related to Avēsis and its customers, following our information security policies. This obligation continues even after employment ends, including secure handling of data and access management - Must be self-motivated and highly organized with the ability to work autonomously without direct supervision - Ability to convey information and engage an audience in a professional setting. - Ability to operate in a fast-paced environment under tight deadlines and deliver high-quality work consistently. - Use virtual platforms like Teams and Microsoft Outlook for collaboration. Participate in regular monthly check-ins and bi-weekly department touch bases for market updates and team alignment. 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 equivalent required. - 2+ years of either Dental Assistant or Dental Hygienist required. - Dental Assistant certificate or 2 years of chair side assisting required. - 2 years of experience reviewing dental x-rays, models, photos, and patient charts required. - Proficiency with Microsoft Office and other Windows-based applications - Strong reading, writing, and professional communication skills - Ability to manage multiple tasks and prioritize work - Adaptability to handle multiple and changing priorities - Effective time management and organizational skills - Access to reliable internet connection (25 MBPS upload/50 MBPS download speed) and an appropriate workspace are essential for success in this remote role. Preferred Qualifications: - X-Ray certification highly desired - Knowledge of Medicare, Medicaid, or commercial insurance - Experience with HCPCS, CPT, CDT, and ICD-10 coding 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: $18.33-$30.55 Zone B: $19.97-$33.29 Zone C: $21.50-$35.84 FLSA Status: Hourly/Non-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!

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. In this role, you will assist with basic UM administrative functions, including provider outreach, fax and email processing, documentation collection, and letter creation, while learning the department’s systems and procedures. You will be expected to complete over 7–12 calls or attempts per hour while maintaining accuracy and timeliness. As a Level 1 team member, you will rely on established guidelines and close supervision to perform tasks, escalating complex issues to senior staff. This role provides the foundation for growth into higher-level administrative positions. Work hours will be determined by your manager and may vary based on location, department needs, and workflow. Mandatory overtime may be required during peak seasons. Core Competencies: - Perform outreach to providers for correction and resubmission if a request is submitted with insufficient information. - Create ad-hoc manual letter requests utilized to communicate with an enrollee and/or provider. These communications are time sensitive and must meet regulatory, accreditation or contractual requirements. - Handle clerical support for the department, including but not limited to receipt and response of incoming and outgoing fax, email transmissions both internal and external, draft/upkeep meeting agendas, meeting minutes. - Support UM leadership and Avēsis’ communication team in the review and routine maintenance of letter template library for accuracy. - Operate in a fast-paced environment under tight deadlines. - Handle outgoing correspondence, including emails, phone calls, and mail. Draft and proofread documents. - Organize and maintain digital files and records, ensuring they are easily accessible and up to date. - Assist with special projects and tasks as assigned, ensuring they are completed on time and to a high standard. - Other duties as assigned. Functional Competencies: - Self-Motivation & Organization: Must be self-motivated and highly organized with the ability to work autonomously without direct supervision. - Flexible Hours: Work hours will be determined by your manager and may vary based on location, department needs, and workflow. Mandatory overtime may be required during peak seasons. - Deadline Adherence: Expected to meet established deadlines and deliver high-quality work consistently. - Virtual Collaboration: Use virtual platforms like Teams and Microsoft Outlook for collaboration. Participate in regular monthly check-ins and bi-weekly department touch bases for market updates and team alignment. - Confidentiality: Maintain strict confidentiality of information related to Avēsis and its customers, following our information security policies. This obligation continues even after employment ends, including secure handling of data and access management. 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 required. - 1-2 years of basic administrative, clerical, or customer service experience. - Proficiency in basic computer skills (data entry, email platforms, Microsoft Office). - Proficiency in accurate data entry, with minimal to no errors. - Exceptional reading and writing with the ability to communicate at a professional level appropriately at all levels of the organization. - Strong organizational and time-management skills, with the ability to manage multiple tasks and priorities effectively. - Ability to think analytically and make independent decisions. - Ability to meet or exceed quality, accuracy, and production standards - Applies and enhances knowledge to complete most tasks independently - Understands and discusses implications of process and policy changes - Manages moderately complex situations through research, analysis, and planning - Sees actions in terms of longer-term goals and contributes to team efficiency - Intermediate computer skills (Excel, Outlook, internal platforms) - Internet & Workspace: A reliable internet connection (25 MBPS upload/50 MBPS download speed) and an appropriate workspace are essential for success in this remote role. Preferred Qualifications: - Previous Administrative Support experience in healthcare or call center environment. - Familiar with dental or vision terminology and prior authorization workflows. - High level of accuracy and attention to detail in all aspects of work. - Strong interpersonal skills, with the ability to work well both independently and as part of a team. - Flexibility and adaptability to handle changing priorities and tasks. - Ability to handle sensitive information with discretion and maintain confidentiality - Proficient with Microsoft applications, SharePoint technology, Teams, and Outlook. 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: $14.35-$20.86 Zone B: $16.00-$22.76 Zone C: $17.00-$24.49 FLSA Status: Hourly/Non-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!