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
...Maintains accurate pre and post trip driver's logs and inspection sheets according to... ...delivery, securely loads product on the truck for delivery to customer locations following... ...up to 12-ton loads on tandem axle 20 ft. straight truck with piggy-backed forklift, 20-ton...
...your role is to support our clients' mental health and personal growth based on the... ...on our platform. This is a freelance remote role with the flexibility to decide your... ...re seeking to partner with International Coaching Federation (ICF) Coaches, Clinical Psychologists...
...training and supplying pilots to regional and major airlines. The role The Aircraft Mechanic position works as a team member performing inspections, repairs and preventative maintenance on piston flight training aircraft. The successful candidate will possess the...
...Position Summary: The Bus Aide assists and supervises children on the bus during transport... ...Support Manager Works Closely with : School Deans, Other aides, and Transportation... ...appropriate in-service and workshop programs and attend any required meetings. 14. Protect the...
...100% Remote U.S. Residents Only Please Note: We are currently hiring only U.S. residents who are legally authorized to work in the... ...collaboration. If youre ready to take your career to the next level , work in a supportive, growth-oriented environment , and...