Claims Operations Associate (Contract) New Job at Reliance Health, Remote

ay95cDMxZHlET3ZzTUxkRGpTZUR4dEt0MUE9PQ==
  • Reliance Health
  • Remote

Job Description

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.

Requirements

  • 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

Benefits

  • 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

Job Tags

Remote job, Contract work, Internship,

Similar Jobs

Public Storage

IT Service Delivery Manager Job at Public Storage

 .... We are expanding our creative team to enhance our consistent and engaging visual brand presence. Description The Manager, IT Service Delivery is responsible for leading and managing the IT Service Delivery team, including the Service Desk and PC Support (Tier 1)... 

Alter Domus

Senior Fund Accountant - Private Equity Job at Alter Domus

 ....alterdomus.com Alter Domus is currently seeking a Senior Fund Accountant to join our Private Equity Fund Services Team at our...  ...otherwise public accounting firm performing audits on private equity or hedge funds; ~ Strong verbal and written communication skills; ~... 

Wells Fargo

Senior Data Software Engineer Job at Wells Fargo

Senior Data Software Engineer Location Westlake, OH : About this role: Wells Fargo is seeking a Senior Data Software Engineer who will support (EFT) The Enterprise Functions Technology group. EFT provides technology solutions and support for Risk, Audit, Finance, Marketing... 

Dickinson Financial Corporation

Bank Products Manager Job at Dickinson Financial Corporation

 ...Summary The Bank Products Manager drives the development and management of banking products for both Academy Bank and Armed Forces Bank, with special expertise and emphasis on the credit card suite of products. The credit card product focus will also encompass offerings... 

Gpac

Paint Estimator: $90K-$120K Job at Gpac

JOB DESCRIPTION: $90K-$120K SEEKING COMMERCIAL PAINT PROJECT MANAGER/ESTIMATOR GPAC: #1 Commercial Paint Recruiting Firm in the Nation: WORK FOR A LEADING CONTRACTOR I am working with a well-respected, firmly established Commercial Paint Contractor seeking an experienced...