Teams at Avēsis

Provide compassionate bilingual (Spanish) customer service to Medicaid dental members via inbound calls. Capture and update member data, research and escalate complex issues, ensure HIPAA compliance, navigate healthcare programs and systems, and work scheduled Eastern Time shifts in a 100% remote call center.

Provides administrative and clerical support for the Utilization Management department. Responsibilities include contacting providers for missing information, processing correspondence and manual letters, managing emails, faxes, phone calls, records, meeting documentation, and letter templates. Ensures communications meet regulatory, accreditation, and contractual requirements while supporting timely claims and authorization workflows. This remote role requires accurate data entry, confidentiality, organization, multitasking, and occasional local mailing-related travel.

Supervise claims staff, workflows, queue management, and daily operations while ensuring timely, accurate processing within contractual and regulatory requirements. Manage inventory, quality, productivity, reporting, audits, training, performance reviews, escalations, claim adjustments, system testing, and process improvement initiatives. Provide guidance on adjudication, coding, payment procedures, and issue resolution while communicating trends and recommendations to leadership and internal stakeholders.