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

Inside Higher Ed

Adjunct Pool for Exercise Sciences and Kinesiology Job at Inside Higher Ed

 ...Posting Number F000348 Position Title Adjunct Pool for Exercise Sciences and Kinesiology Department Kinesiology Division Academic Affairs Faculty Status Per Course Part-time Faculty Supervisor Title Chair Kinesiology Status Per Course... 

Sumeru Solutions

BSA / Scrum Master Job at Sumeru Solutions

 ...Job Title: BSA / Scrum Master Location: West Des Moines Experience: 10 - 12 years Position: 2 Job Summary: We are looking for a Business Systems Analyst / Scrum Master who can support project delivery by managing sprints, coordinating tasks, and driving... 

University of Maryland Global Campus

Vice President Engagement & Chief of Staff Job at University of Maryland Global Campus

 ...Vice President of Engagement & Chief of Staff Office of the Chief Learner Experience & Success Officer Exempt, Regular, Full-Time University...  ...directly to the CLESO, they will ensuretheseamless execution of the CLESO organization's vision and priorities. This... 

Novolex Corporate

Injection Molding Machine Operator Job at Novolex Corporate

 ...EXTRA money to your paycheck by referring friends and family Eligible for monthly bonus based upon plant productivity The Injection Molding Machine Operator will work on a rotating schedule with every other weekend off. Shifts available are below: Night Shift... 

GD Mission Systems

TEMPEST Engineer (up to $20K Sign-On Bonus) - 2nd Shift Job at GD Mission Systems

 ...requirements Posted Date: 11/4/2025 Category: Engineering-Hardware Employment Type: Full Time Hiring Company: General Dynamics Mission Systems, Inc. Basic Qualifications Education Requirements: Requires a Bachelors degree in Electrical Engineering...