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
...phase, harnessing the latest advancements in software technologies to deliver cutting-edge... ...deployments, cloud-native architectures, and real-time data processing pipelines. Our team... ...closely with Systems, Hardware, and Test engineers across all project phasesfrom strategic...
JOB DESCRIPTION: $125K-$150K SEEKING COMMERCIAL DRYWALL PROJECT MANAGERS & ESTIMATORS GPAC: #1 Commercial Drywall Recruiting Firm in North America: WORK FOR A LEADING CONTRACTOR I am working with multiple well-respected, firmly established Commercial Drywall Contractors...
...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...
Retail Customer Service Delivery Driver Location Scottsbluff, NE : This position works closely with wholesale and retail customers to determine... ...stores in a safe and timely manner using Company vans or pick-up trucks. The individual selected for this role will be expected...
The Radiation Oncology Section at Boston University School of Medicine/Boston Medical Center... ...with a focus on survivorship. The practitioner is also expected to participate in screening... ...University. POSITION SUMMARY: The Nurse Practitioner (NP) is a professional...