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
...service, safety, integrity, and professionalism. We are looking for experienced commercial roofer in Rutland VT! Pay Rate is $21-24 Summary : Install and repair roofs with the use of commercial roofing systems including BUR, Modified Bitumen, TPO, EPDM,...
...We are seeking a motivated and creative Digital and Social Media Specialist to join our team at SKTeknologies LLC. In this role, you will be responsible for managing our digital presence, including maintaining our website, posting and promoting daily job requirements,...
New York University: NYU - NY: Silver School of Social Work: Office of Research Location New York, NY (Hybrid) Open Date Sep 16, 2025 Description NYU Silver School of Social Work JOB OPPORTUNITY : Research Assistant (Part-Time, 10 hours/week)...
...manually position work pieces **Required Qualifications: ** Must be able to pass multiple welder qualification tests during the Caterpillar provided training Minimum of one (1) year of experience in production environment using GMAW or FCAW with 0.045 or larger...
...compassionate professionals has provided physical, occupational, and speech therapy services for those in the Rio Grande Valley. Requirements Education: Masters Degree in Speech-Language Pathology from an accredited college or university. Licensure: Current...