Claims Operations Support Associate

Description: The Claims Operations Support Associate supports clinical data and claims operations by extracting, validating, and summarizing information; coordinating system access and compliance requirements; managing operational workflows; and partnering across teams to support timely, accurate claim and case processing. The role requires strong organization, attention to detail, and effective communication when handling sensitive clinical and financial information.

Description: The Claims Operations Support Associate supports clinical data and claims operations by extracting, validating, and summarizing information; coordinating system access and compliance requirements; managing operational workflows; and partnering across teams to support timely, accurate claim and case processing. The role requires strong organization, attention to detail, and effective communication when handling sensitive clinical and financial information.
Candidates must be within driving distance to the corporate office in Plymouth Meeting, PA as this position requires at minimum 1 office day per week.
Requirements:
Clinical Data & Claims Support

• Extract, validate, and summarize essential clinical data.
• Research and resolve missing rates for Level of Care claims.
• Review, log, and attach incoming reconsiderations; complete non-clinical reconsideration reviews.
• Compare and validate resubmitted claims in alignment with client workflows and reimbursement methodology updates, including current and state grouper versions.

• Maintain Claims System Access Requests and EMR access requests for the PVA team.
• Monitor and manage client system requirements, compliance training, and due dates.
• Coordinate EMR access needs across Progeny Health, including new requests, expirations, and termination of access.

• Manage the PVA Support email inbox, including volume tracking, follow-ups, and issue resolution.
• Track and manage incoming disputes received through SFax emails, Claim Shark, PVA Support emails, and office mail.
• Manage, scan, and track PVA mail during a weekly in-office day.
• Monitor SFax and attach reconciliation requests to claims; route work items for assignment.
• Maintain and update SharePoint resources for the PVA team.
• Prepare and manage PVA turnaround time reporting in partnership with the Operations Team Lead.
• Document team meeting minutes, agendas, and operational updates.

• Partner with in-office staff to support scanning of records and mail processing.
• Collaborate with Revenue Cycle Analysts on case updates, follow-ups, and letter operations.

• 1-3 years experience working with healthcare claims, reimbursement workflows, and/or revenue cycle operations.
• Strong understanding of medical terminology, clinical documentation, and hospital record structures.
• Proficiency in reviewing, validating, and summarizing clinical and non-clinical data.
• Ability to manage multiple systems, including EMRs, claims platforms, and secure communication tools such as SFax.
• Excellent organizational skills with the ability to track high-volume workflows, disputes, and follow-ups.
• Strong written and verbal communication skills for cross-functional collaboration.
• High attention to detail and accuracy when handling sensitive clinical and financial information.
• Proficiency with Microsoft Office Suite, including SharePoint, Excel, and Outlook.

• Claims processing knowledge, including an understanding of reimbursement methodologies, state- and client-specific grouper versions, and claim resubmission workflows.
• Experience interpreting coding guidelines, diagnosis-related groups (DRGs), levels of care, and clinical indicators.
• Prior experience in a hospital, payer, or claims auditing environment.
• Familiarity with dispute resolution processes, reconsiderations, and appeals workflows.

• Paid Time Off
• Paid Parental Leave
• Medical, dental, vision benefits
• 401K with company match
• Short- and Long-Term Disability
• Group Life Insurance
• Tuition reimbursement
• Casual work environment