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

Electrical Solutions, Inc.

Electrical Project Manager Job at Electrical Solutions, Inc.

Summary: Perform electrical estimating and project management oversight on projects of various sizes including commercial and industrial type projects. The successful candidate should have a background not only in managing electrical construction but also in electrical... 

Vensure Employer Solutions

Cherry Picker Operator - Erlanger, KY Job at Vensure Employer Solutions

 ...Essential Duties and Responsibilities Operate a cherry picker forklift safely and efficiently. Accurately pick and pull orders based on work assignments. Inspect and maintain equipment to ensure proper functioning. Maintain a clean, organized, and safe work... 

StaffDash

Travel Paramedic Job at StaffDash

 ...Position: Paramedic Location: Port Arthur, TX Job Type: Travel Assignment Overview: Join a private EMS company providing 911 emergency services and inter-facility transfers (IFTs) in Port Arthur, TX. This is a 16-week assignment designed for experienced... 

The HT Group

Security Manager Job at The HT Group

 ...has partnered with our client in search of a fully onsite, Security Manager, Monday thru Friday, 8am - 5pm in the West/Southwest area of...  ...risk-based assessment process and oversees security at our Corporate location, including loss control for jewelry/gem receiving and... 

ATC Marietta

Travel LPN/LVN - Med Surg Job at ATC Marietta

ATC Healthcare is looking for a Licensed Practical/Vocational Nurse! The LPN/LVN provides skilled nursing services to patients in facilities, including hospitals; long term care and psychiatric hospitals; centers for the developmentally disabled; public health facilities...