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

The Job Center Staffing

High-Reach Order Picker (Cherry Picker) Operator Job at The Job Center Staffing

 ...High-Reach Order Picker (Cherry Picker) Operator Picture this: you begin your shift in Shepherdsville or Louisville, conduct quick safety checks, and guide your high-reach order picker smoothly through the aisles. Your focus is precisepick the right items, place them... 

Audubon Companies

Mechanical Engineer, Principal Job at Audubon Companies

Audubon is currently seeking a Part-time Mechanical Engineering Associate, Principal to join our team in our Metairie, LA Office. The Mechanical Engineering Associate, Principal will perform mechanical engineering assignments associated with designing equipment, components... 

omni linen

omni linen , Delivery Driver , No CDL Job at omni linen

 ...?NoDoes the driver need to have a Doubles/Triples Endorsement?NoDoes the driver need to have a Passenger Endorsement?/tdNoFelonies?Dui?5-10 yrsTraffic tickets allowed in the last 3 years?2Any at fault accidents allowed in the last 3 years?NoDo you require... 

C&S Wholesale Grocers, Inc.

Warehouse Order Selector Job at C&S Wholesale Grocers, Inc.

 ...from our distribution centers to our offices - every employee of C&S and their family of companies works to help feed local families, neighbors and communities. As a Warehouse Selector, you'll pick, gather & organize product and prepare orders for delivery to local... 

SSM Health

Oncology Nurse Practitioner Job at SSM Health

 ...SSM Health Cancer Care-Lake St. Louis is seeking an experienced Oncology Nurse Practitioner.The team of board-certified oncologists, specialists and nurse navigators at SSM Health Cancer Care in Lake St Louis offer exceptional care and treatment to support you in your...