The Claims Operations Associate is responsible for managing claims and approvals processes, and the scope of work includes vetting health insurance claims and approval from service providers, reconciling payments and negotiating and uploading claim tariffs.
Key Responsibilities
Examine and approve or reject healthcare providers’ claims to meet set targets.
Investigate claims for fraud, waste, and abuse.
Promptly resolve escalated approval requests for care.
Negotiate tariffs and update the providers’ dashboard and execute other elements of tariff management.
Collaborate with the technology team to improve the processes claims, tariff and approvals management system.
Collaborate with customer success and provider relations teams to ensure customer satisfaction goals.
Minimum of a first degree in medicine, nursing or pharmacy and completion of internship or houseman ship.
Previous experience in a claim examiner role is a major advantage.
Excellent numeracy, analytical and problem-solving skills.
A high-level of responsiveness is essential and openness to working shifts including occasional weekends.
Strong medical and clinical knowledge and experience.
Excellent interpersonal and communication skills.
Renumeration: 250k - 300k
Join a market leader within the Insurance space
Unlimited leave days
Fantastic work culture
Work and learn from some of the best in the industry
Great work-life balance
...ensures that evidence equipment is in proper working condition, and ensures the evidence processing area is clean and organized Fingerprints individuals for AFIS elimination purposes, background checks and other purposes Testifies in various court proceedings;...
...weekends, holidays, overnights. Layovers, extraboard, and team routes. Position responsibilities: The primary duty of the CDL Class A Driver entails the safe and professional operation of a commercial motor vehicle, company equipment, and the courteous delivery of...
**Employment Type:**Full time**Shift:**Day Shift**Description:****Job Title:** Clinical Nurse Specialist / RN Educator - Critical Care**Employment Type:** Full-Time/40 hours per week**Shift:** Day**Responsibilities:**The Nurse Educator/Clinical Practice Specialist...
...Job Summary and Responsibilities CHI St. Vincent Infirmary in Little Rock, AR is seeking a highly motivated and adaptable Intensivist/Hospitalist Physician Assistant to join our growing team. This position offers flexible scheduling and the opportunity to gain valuable...
...Luxury Pool Service Technician Pool Equipment & Water Systems Make a Splash in Your Career with Us! Aqua Blue Pools is looking... ...just another jobit's a hands-on career where you'll diagnose, repair, and ensure customer satisfaction while working with a top-notch...