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
...orders according to assigned load tickets, shrink wrap and label orders and move completed orders to the loading dock area of the warehouse Accurately receive inbound products, replenish and manage inventory as needed Perform pre-shift equipment checks and safely...
...growth across social, search, and retention marketing, aligning with Amazon efforts when needed. They lead audits, develop strategy, and... ...FREE access to MAG School courses and SOP Library! ~ Work schedule is in EST (Monday-Friday only) ~ Opportunities for professional...
Seronda Networks is Hiring: Entry Level Marketing SpecialistAbout Us: At Seronda Networks, we provide innovative solutions that drive success for our clients, while fostering a collaborative environment where our team can grow and thrive. As a member of our team, you...
When we say our community we mean it. UMMC Midtown Campus, one of two campuses of the University of Maryland Medical Center, has had a long history of working to keep our community healthy and has grown to become a trusted teaching hospital for medical and surgical...
...safety, innovation, integrity and community service. We are a Fortune 200 company, 19,000 colleagues strong serving more than 10 million customers at six energy companies -- Atlantic City Electric (ACE), Baltimore Gas and Electric (BGE), Commonwealth Edison (ComEd),...