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
...A prominent think tank in Washington, DC, seeks a Senior Designer & Motion Graphics Editor to lead creative output efforts. The ideal candidate will have 3-5 years of experience in motion graphic video editing, with expertise in Adobe software. This role involves shaping...
...Location:FL-Jacksonville Job Title: Traffic Anchor/Reporter - WFOX TV Position Overview CBS47/FOX30 Action News Jax is looking for its next Traffic Anchor/Reporter in sunny Jacksonville, Florida!The job involves anchoring traffic 5 days a week and enterprise...
...moving equipment, etc. typically found at busy shipping location Driver may be required to complete tasks inside the warehouse depending... ...following: driver will be required to operate a hostler truck/yard goat. Employee will be required to open trailer doors, slide...
...and why you teach it, we'd love for you to be part of Togetherhood. What You'll Do We are looking for an instructor to teach dance to PreK and Kindergartnersat a school in Princeton, NJ, starting this October 2025. Joining our network means we can also match you...
...Job Title: Content Writer Pay Information: Exempt E12- $76,500- $90,000 per year Location: Remote first work environment with occasional travel and in office meetings. Who we are: The California Dental Association is a membership organization...