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
...Position : Clinicals Trials Research Nurse Location : Upper Valley Medical Center Shift : Full Time/ 8:00 AM- 4:30 PM/ (80 hours per pay) The Research Nurse is responsible for providing expertise in the review and implementation of clinical trials for patients...
...well with others, and are driven to succeed. No detailing experience? No problem. Well train you hands-on and pay you while you learn. Who Were Looking For: Driver's license required. Ambitious and willing to work hard. Wants to grow...
...INTEGRITY. SERVICE. STEWARDSHIP . We have a passion for purpose driven work! Do you? JOIN OUR FAMILY! Provide palliative nursing care and support to pediatric patients and families WHAT YOU WILL DO: Assess physical, psychosocial and spiritual needs...
...limitations. Design, implement, and enhance Model Context Protocol (MCP) servers for component libraries. Architect and develop multi-step AI agents integrated with UI frameworks and component libraries. Ensure AI agents are reliable, scalable, and...
173944 Job Description Deliver evidence-based sexual health education to young people ages 12-21 in school and community-based settings. Develop and implement positive youth development programs for afterschool initiatives. Job Responsibility Implements age appropriate...