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
...We prefer prior experience in a warehouse or packaging environment but we are open to training the right employees. We are a relocation business specializing in moving, assembling and repair. We offer a variety of other services as well. Responsibilities: Moving...
...We are seekingto add a Data Entry Administrator to our team!You will be responsible for accurate data entry, file maintenance, and record keeping. Responsibilities: Enter variety of data using current technology Prepareand sort documents for data entry...
...experience in WordPress Development.* Experience with BigCommerce, Magento, and Shopify (preferred).* Experience with ReactJS/... ...and power if working remotely. **Your Duties and Tasks:*** Developing and providing maintenance support for WordPress sites.*...
DescriptionAmazon Ads is dedicated to driving measurable outcomes for brand advertisers, agencies, authors, and entrepreneurs. Our ad solutions-including Twitch and Prime Video ADs-leverage Amazon's innovations and insights to find, attract, and engage intended audiences...
...clients vision. LJC is a growing firm and is recruiting top talent to join our growing team. The Role We Want You For As an Interior Designer, you will contribute to a variety of design projects to support our diverse and innovative Interior Design practice. This...