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
...licensure, and internal equity. Hourly pay is just one part of the compensation package for employees. Job Summary The Dietary Aide is responsible for providing high-quality meal service to residents, staff, and visitors in a long-term care environment. This position...
...Job Summary: The purpose of a paramedic position is to provide basic and advanced life supportand emergency medical techniques to those in need of assistance. Participating in continuing education and training relative to medical and industry advancements in vital to...
...NOW HIRING CAREGIVERS FOR SENIORS IN THE WEST NEWTON AREA! Were looking for compassionate people to join our team in Waltham and West Newton. Full-time or part-time your choice. Weve got short, 23 hour shifts available in both the morning (8:00 AM10:00 AM) and...
HEAVY ELECTRICAL PROJECT MANAGER Gpac is a national executive search firm for the nation's premier electrical contractors and industry professionals. Gpac has been retained by a confidential client to conduct a search for the position of Electrical Project Manager ....
Embark on a rewarding journey as a Licensed Practical Nurse (LPN) in Utica, New York, where your hands-on care and compassionate presence... ...the lives of patients and families during every shift. This travel-facing opportunity is designed for LPNs who want to deepen their...