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

Global Community Charter School

Middle School Math Teacher Job at Global Community Charter School

 ...TITLE: Middle School Math Teacher DEPARTMENT: Instructional REPORTS TO: Principal or Designee DATE PREPARED/REVISED: March 25, 2025 JOB DESCRIPTION PRIMARY FUNCTIONS AND POSITION OVERVIEW Global Community Charter School (GCCS) is a Harlem-based... 

Tekla Research

Air Traffic Control and Landing Systems (ATC&LS) Flight Test Engineer Job at Tekla Research

 ...Must be a U.S. Citizen Clearance Required: Top Secret Functional Description: Project Engineer in the Air Traffic Control & Landing Systems (ATC&LS) Branch, supporting Test and Evaluation (T&E) of PMA-213 Projects, including but not limited to Precision Approach... 

HCA Healthcare

Anesthesia Tech Job at HCA Healthcare

 ...**Introduction**Last year our HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a(an) Anesthesia Tech with Rio Grande Regional Hospital you can be a part of an organization that is devoted to giving back!**Benefits**Rio Grande... 

University of Massachusetts Boston

Assistant/Associate Professor (Educational Leadership/Community Schools) Job at University of Massachusetts Boston

The Leadership in Education Department in the College of Education and Human Development (CEHD) at the University of Massachusetts Boston seeks applicants for a tenure-track Assistant/Associate Professor to begin September 1, 2026, in the Educational Leadership for Social... 

SGS Consulting

Demand Planner II Job at SGS Consulting

 ...manufacturing documentation by supporting creation of build books. Collaborate with SIOP on long-range forecasting. Coordinate outsourcing to third parties and sister sites. Attend internal kickoff and baseline meetings. Skills: ~ Proficiency in Microsoft...