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
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...
...of reach, including $2,500 annual savings per patient, improved mental health and a Net Promoter Score of 94. We're making waves: on CNN ( in WaPo ( at the Fed ( is even a new Medicare billing code ( for Community Health Workers that is modeled after IMPaCT. We're changing...
Embark on a transformative journey as a Licensed Practical Nurse (LPN) in the state of Washington, with a focused assignment in Tacoma... .... This role isnt limited to a single location; our nationwide travel program provides opportunities to work across the United States,...
Registered Nurse RN - Large Senior Living CommunityWe are seeking an outstanding Registered Nurse to join our team at Overlake Terrace... ...Nurse provides support to the Director of Health and Wellness and can take many of the responsibilities and tasks of the Director...
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...