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
...Interior Architect / Interior Designer Shape the Future of Interior Spaces Are you a talented and passionate designer with a deep understanding of both architecture and interior design? Do you thrive on creating spaces that are not only beautiful but also functional...
...Are you ready to join a dynamic team that thrives on performance, teamwork, and personal growth? At Wavedash Marketing, we operate like a high-performing sports team driven, supportive, and constantly pushing for the next win. If you're passionate about learning, growing...
...Description The Security Manager is responsible for the oversight of the safety and security of the hotel. This person will respond to guest and employee emergencies, supervise and train the security staff. A minimum of two years of security experience, good communication...
# Design and develop backend applications using Python frameworks such as Django , Flask , or FastAPI . # Write clean, efficient, and maintainable code following best practices. # Develop and maintain RESTful APIs for web and mobile applications. # Integrate...
Join our experienced andgrowing team as an Intensivist Physician north of Boston. We are a leadinghospital medicine and critical care group providing high-quality staffing formultiple hospitals across Massachusetts. Our unwavering commitment to excellencein patient...