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
...shifts every two weeks. Come build your EMS career where you can build your life. WHAT YOU NEED TO APPLY: A National or State Paramedic License. Valid driver license with an insurable record. Be at least 20 years old by the time you start work. Ability to...
Amex GBT is a place where colleagues find inspiration in travel as a force for good and - through their work - can make an impact on our industry. We're here to help our colleagues achieve success and offer an inclusive and collaborative culture where your voice is valued...
...Michelin North America, Inc. has an immediate opening for a Corporate Security Director covering all entities under the Regions responsibility... ...matters, including but not limited to, security risk management, crisis response, and regulatory compliance. Lead enterprise...
...Summer 2026 Legal Intern - Norfolk, Virginia Corporate Office Harbor Group International... ...HGI) is a leading global private equity real estate investment manager with approximately $2... ...have an interest in multifamily and commercial real estate and be prepared to work individually...
807 INSURANCE BILLING SPECIALIST Location Fayetteville, NC : Immediate opening!!! Must have... ...and detail-oriented Revenue Cycle Medical Specialist to join our primary care team.... ...: Strong knowledge of medical billing codes (CPT, ICD-10) and billing software. Excellent...