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
WANT TO GROW YOUR CAREER?Come and Grow With The UPS Store - MacSoup!MacSoup has proudly served the Austin community for over 10... ...and operated locations. Our centers offer a variety of shipping, freight, postal, digital online printing, document, and business services...
...training. Willingness to learn and take direction. Must pass a criminal background check. Availability on Fridays and Sundays, with some Saturdays as needed. Hardworking and able to establish priorities effectively. Strong attention to detail and commitment to...
...Description: Full time Management role Salaried position Benefits available 403(b) Retirement PlanSaints John and Paul Catholic Parish is seeking a Director of Religious Education (DRE) . The DRE is responsible for overseeing the parish catechetical/faith...
Whittier Rehabilitation Hospital - Haverhill/Bradford Director of Medical Records Full-Time, 40 hours/week Base pay $104, 000 - $114.400 Hybrid between Bradford & Westborough locations The Director of Medical Records oversees day to day HIM operations, ...
..., our friendly team of European Service at Home has a vacancy open for a Caregiver in the following town: 1. Niles 1 person (Polish Speaking) You can apply right now using the link below: Our benefits: Paid training Flexible scheduling Competitive pay...