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
Requirements:Minimum 5 years experience in hotel or commercial security managementStrong crisis management and leadership skillsExperience in international hotels or high-security environments preferred Responsibilities:Manage hotel security team and daily security...
...Join our Team as aInternational Travel and Tourism Consultant! Do you have a passion for travel and a knack for planning unforgettable experiences? As a International Travel and Tourism Consultant , youll help clients bring their dream vacations to life. From tropical...
...equipment, and test articles that push the state of the art of bearings, gear systems, rotor/stator seals, and rotordynamics. At GE Aerospace Research, scientists, engineers, and technicians innovate for the future of flight. An internship with us will provide valuable...
...Unidine is hiring immediately for FULL TIME BACK OF HOUSE LEAD position. Location : Moorings Park-120 MOORINGS PARK DR NAPLES FL 34105 Schedule : FT; More information upon interview. Requirement : Minimum 4-5 years of experience in a high-volume kitchen...
...Now Hiring: UI Developer Location: 100% Remote Duration: Long-term contract What You'll Do: Build responsive and interactive user interfaces Work with modern frontend frameworks (React, Angular, or Vue) Collaborate with designers and developers...