Claims Operations Associate (Contract) New Job at Reliance Health, Remote

ay95cDMxZHlET3ZzTUxkRGpTZUR4dEt0MUE9PQ==
  • Reliance Health
  • Remote

Job Description

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.

Requirements

  • 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

Benefits

  • 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

Job Tags

Remote job, Contract work, Internship,

Similar Jobs

FACEGYM

Esthetician (Trainer) LA Job at FACEGYM

 ...Our Company Brand: FACEGYM is the first of its kind and a unique facial fitness experience, and is in the confidence-boosting business. Think of us as a complete gym workout for your face. We combine powerful kneading movements with our high-performance skincare, innovative... 

Children's Mercy KC

Maternal Fetal Medicine Physician - Children's Mercy KC - Kansas City, Missouri, United States Job at Children's Mercy KC

 ...been recognized by U.S. News & World Report as a top pediatric hospital, for eleven consecutive years. Childrens Mercy is in the...  ...clinical services. Childrens Mercy Fetal Health Center is a state-of-the-art prenatal diagnosis facility, one of only a handful... 

mylife2liveinc

Medical Billing and Coding Specialist Paid Internship Program Job at mylife2liveinc

 ...wave, which begins on9 September 2019 , to become Certified Medical Billing and Coding Specialists for a new client! Join us today...  ...,college classes, disabilities, and so much more! PAID internship! What you receive from Code Life MD: All of your lessons... 

School Gig

Middle School Dance Teacher Job at School Gig

 ...Job Summary: Santa Rosa City Schools is seeking a creative and enthusiastic Dance Teacher to join our vibrant educational team at Santa Rosa Middle School. This is a part-time (.20 FTE), certificated position, ideal for educators passionate about fostering students'... 

Evolution Sports Group

Remote eSports Coordinator / Virtual Training Assistant Job at Evolution Sports Group

 ...Remote position Position: Remote eSports Coordinator / Virtual Training Assistant Company Overview: Evolution Sports Group is a leading organization in the eSports industry, dedicated to providing top-notch virtual training and competitive opportunities...