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
...SSM Health Cancer Care-Lake St. Louis is seeking an experienced Oncology Nurse Practitioner.The team of board-certified oncologists, specialists and nurse navigators at SSM Health Cancer Care in Lake St Louis offer exceptional care and treatment to support you in your...
...High-Reach Order Picker (Cherry Picker) Operator Picture this: you begin your shift in Shepherdsville or Louisville, conduct quick safety checks, and guide your high-reach order picker smoothly through the aisles. Your focus is precisepick the right items, place them...
Retail Customer Service Delivery Driver Location Scottsbluff, NE : This position works closely with wholesale and retail customers to determine... ...stores in a safe and timely manner using Company vans or pick-up trucks. The individual selected for this role will be expected...
...The Clinical Assistant (CA) serves as the primary liaison between patients and Providers. The CA provides care and related services to patients in medical centers. We offer multiple site locations (4). Essential Job Duties: Accurately record vital signs and pertinent...
...base pay! Plus, we believe in work-life balance - our week ends at 3:00 PM on Fridays!Position OverviewWe are seeking a Medical Office Manager to oversee the daily operations of our sleep clinics and lead our team with professionalism, efficiency, and care. This is...