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
...Brown and Caldwell, a national environmental engineering firm, has an exciting opportunity for an entry level engineer to work on design infrastructure projects for municipal and private sector clients in our Las Vegas, NV office. You will provide civil/mechanical engineering...
..., and immediate investigation and resolution using host-based, network-based and cloud-based cybersecurity analysis capabilities. Team... ...malicious cyber activity. They are seeking Cyber Network Defense Analysts (CNDA) to support this critical customer mission. The CNDA...
...We are seeking an infusion nurse (RN) with IVIg experience interested in providing in-home infusions for a local patient. Infusion Details... ...THURSDAYS ONLY due to work schedule Responsibilities of the PRN Home Infusion Registered Nurse Deliver immune globulin...
Job Title: Electrical EstimatorJob DescriptionWe are seeking a skilled Electrical Estimator to join our team, where you will play a crucial role in evaluating project plans, specifications, and bid documents to create accurate and competitive bid proposals. Your expertise...
...Job Description We are seeking a reliable and dedicated owners/operator Delivery Driver to join our team. Individuals must have their own cars, minivans, or cargo vans to deliver the freight. The ideal candidate will be responsible for transporting goods efficiently and...