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
What's This All About?Perfect Search offers a Remote Digital Marketing Internship program focused on learning pay-per-click advertising/search engine marketing (PPC/SEM), display/programmatic advertising, and social media advertising, as well as search engine optimization...
...Grumman Missions Systems Sector seeks a **Senior Principal Business Development Operations Analyst (Level 4)** to support Mission Systems Sector strategy... ...as well as maintain data quality metrics in SalesForce.**_The candidate will manage or conduct the following...
...offer a full range of services from refinery turnarounds and offshore construction to custom supervisory control and data acquisition... ...the nation. The management team at Rabalais brings a combined experience of over 500 years to each project the company undertakes.**Summary...
...either alone or with team members - to customer sites both on and offshore with company supplied equipment to meet with customer to... ...its stakeholders are precise. Travel required up to 15% of the time. Other duties may be assigned. Required Experience: IC...
Nemours Children's Hospital, Florida is seeking a dynamic and innovative, full-time Pediatric Hospitalist to join our growing team of physicians. This position gives ample opportunity for professional growth and involvement with medical education at all levels. Our division...